Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Neurosurg. 2013 Sep;119(3):642-7. doi: 10.3171/2013.5.JNS1331. Epub 2013 Jun 21.
Carotid artery stenting (CAS) can be an alternative option for carotid endarterectomy in the prevention of ischemic stroke caused by carotid artery stenosis. The purpose of this study was to evaluate the influence of stent design on the incidence of procedural and postprocedural embolism associated with CAS treatment.
Ninety-six symptomatic and asymptomatic patients, consisting of 79 males and 17 females, with moderate to severe carotid artery stenosis and a mean age of 69.0 years were treated with CAS. The stent type (48 closed-cell and 48 open-cell stents) was randomly allocated before the procedure. Imaging, procedural, and clinical outcomes were assessed and compared. The symptomatic subgroup (76 patients) was also analyzed to determine the influence of stent design on outcome.
New lesions on postprocedural diffusion-weighted imaging (DWI) were significantly more frequent in the open-cell than in the closed-cell stent group (24 vs 12, respectively; p = 0.020). The 30-day clinical outcome was not different between the 2 stent groups. In the symptomatic patient group, stent design (p = 0.017, OR 4.173) and recent smoking history (p = 0.036, OR 4.755) were strong risk factors for new lesions on postprocedural DWI.
Stent design may have an influence on the risk of new embolism, and selecting the appropriate stent may improve outcome.
颈动脉支架置入术（CAS）可作为颈动脉内膜切除术的替代方案，用于预防颈动脉狭窄引起的缺血性卒中。本研究旨在评估支架设计对 CAS 治疗相关术中及术后栓塞事件发生率的影响。
96 例症状性和无症状性颈动脉中重度狭窄患者（79 例男性，17 例女性），平均年龄 69.0 岁，接受了 CAS 治疗。在术前随机分配支架类型（48 枚密网支架和 48 枚开口支架）。评估并比较了影像学、手术过程和临床结果。还对症状性亚组（76 例患者）进行了分析，以确定支架设计对结果的影响。
术后弥散加权成像（DWI）上新病灶在开口支架组明显多于密网支架组（分别为 24 例和 12 例；p=0.020）。两组 30 天临床结局无差异。在症状性患者组中，支架设计（p=0.017，OR 4.173）和近期吸烟史（p=0.036，OR 4.755）是术后 DWI 上新病灶的强烈危险因素。
支架设计可能对新发栓塞的风险有影响，选择合适的支架可能改善结局。
