Piccoli Gianluca, Biondi-Zoccai Giuseppe, Gavrilovic Vladimir, Radici Viviana, Cancelli Iacopo, Frigatti Paolo, Frati Giacomo, Marullo Antonino G M, Divis Paolo, Gasparini Daniele
S. Maria della Misericordia University Hospital, Udine, Italy
Sapienza University of Rome, Latina, Italy.
J Endovasc Ther. 2015 Apr;22(2):212-6. doi: 10.1177/1526602815573498.
To investigate if drug-coated balloon (DCB) predilation may improve the efficacy of carotid artery stenting (CAS) for restenosis after carotid endarterectomy (CEA).
Eighteen consecutive patients (11 men; median age 75 years) with significant restenosis within 24 months of CEA were treated with a paclitaxel-coated DCB prior to CAS. Clinical outcomes and stent patency were systematically appraised.
All patients were successfully treated according to this clinical protocol. The only complication occurred in a patient who had a transient ischemic attack during prolonged DCB inflation. At a median follow-up of 18 months, no >50% restenosis was observed on duplex ultrasound scans; however, moderate hyperplasia at the proximal stent edge was found in 4 patients. One patient died at 9 months from a myocardial infarction.
Despite the small sample size and in keeping with the historically high risk of recurrent restenosis after CAS for CEA restenosis, this case series suggests that DCB dilation followed by CAS for postsurgical restenosis is feasible, safe, and may be associated with favorable clinical outcomes at midterm follow-up.
探讨药物涂层球囊（DCB）预扩张是否可提高颈动脉支架置入术（CAS）治疗颈动脉内膜切除术（CEA）后再狭窄的疗效。
18例CEA术后24个月内出现明显再狭窄的连续患者（11例男性；中位年龄75岁）在CAS前接受了紫杉醇涂层DCB治疗。系统评估临床结局和支架通畅情况。
所有患者均按照该临床方案成功治疗。唯一的并发症发生在1例在DCB长时间扩张期间出现短暂性脑缺血发作的患者身上。中位随访18个月时，双功超声扫描未观察到>50%的再狭窄；然而，4例患者在支架近端边缘发现中度增生。1例患者在9个月时死于心肌梗死。
尽管样本量小，且与CAS治疗CEA再狭窄后复发性再狭窄的历史高风险一致，但该病例系列表明，DCB扩张后行CAS治疗术后再狭窄是可行、安全的，且在中期随访时可能具有良好的临床结局。
