Khan Muhib, Qureshi Adnan I
Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI.
Zeenat Qureshi Stroke Institute, St. Cloud, MN.
J Vasc Interv Neurol. 2014 May;7(1):11-20.
We provide an assessment of clinical, angiographic, and procedure related risk factors associated with stroke and/or death in patients undergoing carotid artery stent placement which will assist in patient stratification and identification of high-stent risk patients.
A comprehensive search of Medline from January 1st 1996 to December 31st 2011 was performed with key words "carotid artery stenosis", " carotid artery stenting", "carotid artery stent placement", "death" , " mortality", "stroke", "outcome", "clinical predictors", "angiographic predictors", was performed in various combinations. We independently abstracted data and assessed the quality of the studies. This analysis led to the selection of 71 articles for review.
Clinical factors including age≥80 years, symptomatic status, procedure within 2 weeks of symptoms, chronic renal failure, diabetes mellitus, and hemispheric TIA were associated with stroke (ischemic or hemorrhagic) and death within 1 month after carotid artery stent placement. Angiographic factors including left carotid artery intervention, stenosis > 90%, ulcerated and calcified plaques, lesion length > 10mm, thrombus at the site, ostial involvement, predilation without EPD, ICA-CCA angulation > 60%, aortic arch type III, and aortic arch calcification were also associated with 1 month stroke and/or death. Intra-procedural platelet GP IIb/IIIa inhibitors, protamine use, multiple stents, predilatation prior to stent placement were associated with stroke (ischemic or hemorrhagic) and death after carotid artery stent placement. Intraprocedural use of embolic protection devices and stent design (open versus closed cell design) did not demonstrate a consistent relationship with 1 month stroke and/or death. Procedural statin use, and operator and center experience of more than 50 procedures per year were protective for 1 month stroke and/or death.
Our review identified risk factors for stroke, death, and MI within 1 month in patients undergoing carotid artery stent placement. Such information will result in better patient selection for carotid artery stent placement particularly in those who are also candidates for carotid endarterectomy.
我们对接受颈动脉支架置入术的患者中与卒中及/或死亡相关的临床、血管造影及手术相关危险因素进行了评估，这将有助于患者分层并识别高支架风险患者。
对1996年1月1日至2011年12月31日期间的Medline进行了全面检索，使用关键词“颈动脉狭窄”“颈动脉支架置入术”“颈动脉支架放置”“死亡”“死亡率”“卒中”“结局”“临床预测因素”“血管造影预测因素”，以各种组合进行检索。我们独立提取数据并评估研究质量。该分析导致选择了71篇文章进行综述。
临床因素包括年龄≥80岁、症状状态、症状出现2周内进行手术、慢性肾功能衰竭、糖尿病和半球性短暂性脑缺血发作，与颈动脉支架置入术后1个月内的卒中（缺血性或出血性）及死亡相关。血管造影因素包括左颈动脉干预、狭窄>90%、溃疡和钙化斑块、病变长度>10mm、病变部位血栓、开口受累、无血管内保护装置的预扩张、颈内动脉-颈总动脉夹角>60°、主动脉弓III型和主动脉弓钙化，也与1个月内的卒中和/或死亡相关。术中使用血小板糖蛋白IIb/IIIa抑制剂、使用鱼精蛋白、多个支架、支架置入前预扩张与颈动脉支架置入术后的卒中（缺血性或出血性）及死亡相关。术中使用栓子保护装置和支架设计（开放细胞设计与闭合细胞设计）与1个月内的卒中和/或死亡未显示出一致的关系。术中使用他汀类药物以及每年手术量超过50例的术者和中心经验对1个月内的卒中和/或死亡具有保护作用。
我们的综述确定了接受颈动脉支架置入术的患者在1个月内发生卒中、死亡和心肌梗死的危险因素。这些信息将有助于更好地选择适合颈动脉支架置入术的患者，特别是那些也适合颈动脉内膜切除术的患者。
