Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical Informatics and Integrative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
J Stroke Cerebrovasc Dis. 2014 Jan;23(1):148-54. doi: 10.1016/j.jstrokecerebrovasdis.2012.11.019. Epub 2012 Dec 25.
The aim of this study was to clarify both the present status of treatment for carotid stenosis with highly calcified plaques and the appropriate treatment.
A total of 140 consecutive treatments for carotid stenoses (carotid endarterectomy [CEA]:carotid artery stenting [CAS] 81:59) were enrolled in the study. We classified the patients into low-calcified plaque (LCP) and high-calcified plaque (HCP) groups by calcium score, determined by a receiver operating characteristic analysis, and we compared the results after both treatments.
The mean degree of residual stenosis and improvement rates of the stenosis after CAS for the HCP group were 9.7% ± 13.3% and 87.0% ± 16.8%, respectively, whereas those for the LCP group were 1.7% ± 6.1% and 97.9% ± 7.9% (both P < .001). A multiple logistic regression analysis revealed that only the calcium score was an independent pre-CAS predictor of residual stenosis. Restenosis at 6 months was observed frequently in the HCP group after both CAS and CEA (18.8% and 20.0%, respectively). Cerebral hyperperfusion syndrome was observed in 2 cases of CAS, 1 for each plaque group. The 30-day and 6-month rates for any stroke or death after CAS were 2.3% and 12.5% for the LCP and HCP groups, respectively, whereas those after CEA were 1.6% and 0%.
Carotid stenoses with HCP (calcium score ≥420) treated by CAS showed a disadvantage in the degree of stent expansion compared to carotid stenoses with LCP, suggesting that CEA may be recommended as a surgical option.
本研究旨在阐明高度钙化斑块所致颈动脉狭窄的治疗现状及适宜的治疗方法。
共纳入 140 例连续颈动脉狭窄（颈动脉内膜切除术 [CEA]：颈动脉支架置入术 [CAS]，81:59）患者。我们通过接受者操作特征分析将患者分为低钙斑块（LCP）和高钙斑块（HCP）组，并比较两种治疗方法的结果。
HCP 组 CAS 后残余狭窄程度及狭窄改善率分别为 9.7%±13.3%和 87.0%±16.8%，而 LCP 组分别为 1.7%±6.1%和 97.9%±7.9%（均 P<0.001）。多因素逻辑回归分析显示，只有钙评分是 CAS 后残余狭窄的独立预测因素。HCP 组患者在 CAS 和 CEA 后 6 个月均有较高的再狭窄率（分别为 18.8%和 20.0%）。2 例患者（每组各 1 例）在 CAS 后出现脑过度灌注综合征。LCP 和 HCP 组患者在 CAS 后 30 天和 6 个月的任何卒中或死亡发生率分别为 2.3%和 12.5%，CEA 后分别为 1.6%和 0%。
与 LCP 相比，HCP（钙评分≥420）患者的 CAS 支架扩张程度较差，提示 CEA 可能是一种更优的手术选择。
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