Pelz David M, Lownie Stephen P, Lee Donald H, Boulton Melfort R
Departments of Medical Imaging and Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
J Neurosurg. 2015 Oct;123(4):856-61. doi: 10.3171/2014.9.JNS14811. Epub 2015 Mar 27.
Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of embolic protection devices and balloon angioplasty, has been shown to be effective and faster, cheaper, and potentially safer than conventional techniques. However, the long-term morphological results of this technique have not been established. The aim of this study was to determine whether preprocedural carotid plaque imaging at the site of maximal stenosis by using CT angiography (CTA) could predict the long-term morphological outcome of primary carotid stenting.
One hundred eighty-one patients were treated over an 11-year period. Preprocedural CTA was performed in 102 of these. A morphological scale (the Predicting Long-term outcome with Angioplasty of the Carotid artery [PLAC] Scale), with grades from 0 to 4 and A or B, was used to evaluate the circumferential degree of plaque calcification, and the presence or absence of soft plaque. All patients were followed using duplex carotid ultrasound and plain radiographs. Satisfactory morphological outcome was defined as a peak systolic velocity < 120 cm/s and internal carotid artery/common carotid artery ratio < 1.4.
The average follow-up duration was 29.7 months (median 24.5 months, range 0.3-87 months). Univariate logistic regression demonstrated that a low calcification grade (p < 0.001), less thick calcification (p < 0.001), and moderate amounts of soft plaque (p < 0.001) are factors that are highly associated with good long-term outcome. Multivariate analyses confirmed that these factors are independent of each other in predicting outcome.
The long-term morphological outcome of primary carotid stenting was predicted with considerable accuracy by using a straightforward CTA carotid plaque grading scale.
颈动脉血管成形术和支架置入术已成为治疗动脉粥样硬化性颈动脉狭窄的颈动脉内膜切除术的替代方法。单纯使用自膨式支架进行的原发性颈动脉支架置入术，不刻意使用栓子保护装置和球囊血管成形术，已被证明比传统技术更有效、更快、更便宜且可能更安全。然而，该技术的长期形态学结果尚未确定。本研究的目的是确定通过CT血管造影（CTA）在最大狭窄部位进行术前颈动脉斑块成像是否能预测原发性颈动脉支架置入术的长期形态学结果。
在11年期间对181例患者进行了治疗。其中102例患者进行了术前CTA检查。使用一种形态学评分量表（颈动脉血管成形术预测长期结果[PLAC]量表），评分从0到4以及A或B，来评估斑块钙化的圆周程度以及软斑块的有无。所有患者均通过双功能颈动脉超声和X线平片进行随访。满意的形态学结果定义为收缩期峰值速度<120 cm/s且颈内动脉/颈总动脉比值<1.4。
平均随访时间为29.7个月（中位数24.5个月，范围0.3 - 87个月）。单因素逻辑回归显示，低钙化等级（p < 0.001）、较薄的钙化（p < 0.001）和中等量的软斑块（p < 0.001）是与良好长期结果高度相关的因素。多因素分析证实这些因素在预测结果方面相互独立。
使用简单的CTA颈动脉斑块分级量表可以相当准确地预测原发性颈动脉支架置入术的长期形态学结果。
