Department of Vascular Surgery, Attikon University Hospital, Athens, Greece.
J Vasc Surg. 2013 Nov;58(5):1402-7. doi: 10.1016/j.jvs.2013.07.111. Epub 2013 Sep 24.
Carotid artery stenting (CAS) is usually performed with femoral access; however, this access may be impeded by anatomic limitations. Moreover, many embolic events happen during aortic arch catheterization. To overcome these problems, transcervical access to the carotid artery can be used as an alternative approach for CAS.
An electronic search of the literature using PubMed was performed. All studies reporting the results of CAS using the transcervical approach were retrieved and analyzed.
The analysis included 12 studies reporting the results of 739 CAS procedures performed in 722 patients (mean age, 75.5 years). Of 533 lesions reported, 235 (44%) were symptomatic, with no data regarding symptomatic status available for 206 lesions. Two techniques were used: direct CAS with transcervical access (filter protected or unprotected) in 250 patients and CAS with transcervical access under reversed flow (with arteriovenous shunt in most cases) in 489 patients. Local anesthesia was used in 464 of 739 procedures (63%), and the remaining were performed under general anesthesia or cervical block. Technical success was 96.3% for 579 procedures with available data (558 successful procedures and 21 failures: inability to cross the lesion, 10; dissection, 5; failure of predilatation, 1; stent thrombosis, 1; patient agitation, 1; and no data, 3). The incidence of conversion to open repair was 3.0% (20 of 579 procedures: 18 carotid endarterectomies and two common carotid-internal carotid bypass grafts). Stroke occurred in eight patients (two fatal) and a fatal myocardial infarction in one patient. The incidence of stroke, myocardial infarction, and death was 1.1%, 0.14%, and 0.41%, respectively. The incidence of stroke was 1.2% (3 of 250) in direct CAS with transcervical access and 1.02% (5 of 489) in CAS under reversed flow (P > .05). Transient ischemic attack occurred in 20 patients (2.7%). Local complications were encountered in 17 of 579 CAS (2.9%), comprising 15 hematomas and two patients with transient laryngeal palsy.
CAS with the transcervical approach is a safe procedure with low incidence of stroke and complications. It can be used as an alternative to femoral access in patients with unfavorable aortoiliac or aortic arch anatomy.
颈动脉支架置入术（CAS）通常通过股动脉入路进行；然而，这种入路可能会受到解剖限制。此外，许多栓塞事件发生在主动脉弓导管插入过程中。为了克服这些问题，可以使用经颈入路作为 CAS 的替代方法。
使用 PubMed 对文献进行电子检索。检索并分析了所有报道经颈入路行 CAS 结果的研究。
分析纳入了 12 项研究，共报告了 722 例患者（平均年龄 75.5 岁）739 例 CAS 手术的结果。报告了 533 处病变，其中 235 处（44%）为症状性病变，206 处病变无症状状态数据不详。使用了两种技术：250 例患者采用经颈直接 CAS（带或不带滤器保护），489 例患者采用经颈逆行血流 CAS（大多数情况下使用动静脉分流）。464 例（63%）手术采用局部麻醉，其余手术采用全身麻醉或颈部阻滞。579 例（558 例成功，21 例失败：病变无法通过 10 例，夹层 5 例，预扩张失败 1 例，支架内血栓形成 1 例，患者躁动 1 例，无数据 3 例）手术技术成功率为 96.3%。转为开放修复的发生率为 3.0%（20/579 例：18 例颈动脉内膜切除术和 2 例颈总动脉-颈内动脉旁路移植术）。8 例患者发生卒中（2 例致死）和 1 例致死性心肌梗死。卒中、心肌梗死和死亡的发生率分别为 1.1%、0.14%和 0.41%。直接经颈 CAS 的卒中发生率为 1.2%（250 例中的 3 例），逆行血流下 CAS 的卒中发生率为 1.02%（489 例中的 5 例）（P>0.05）。20 例（2.7%）患者发生短暂性脑缺血发作。579 例 CAS 中有 17 例（2.9%）发生局部并发症，包括 15 例血肿和 2 例暂时性喉返神经麻痹。
经颈入路行 CAS 是一种安全的手术方法，卒中发生率和并发症发生率均较低。对于股动脉入路解剖条件不佳的患者，可作为其替代方法。
