Juszkat Robert, Liebert Włodzimierz, Stanisławska Katarzyna, Tomczyk Tomasz, Wronka Jarosław, Wąsik Norbert, Perek Bartłomiej
Department of General and Interventional Radiology, Poznań University of Medical Sciences, 1/2 Długa St., 61-848, Poznan, Poland.
Department of Neurosurgery, Poznań University of Medical Sciences, 49 Przybyszewskiego St., 60-355, Poznan, Poland.
Cardiovasc Intervent Radiol. 2015 Dec;38(6):1451-7. doi: 10.1007/s00270-015-1101-8. Epub 2015 Apr 23.
Treatment of choice for the internal carotid artery dissection (ICAD) is anticoagulation for three to 6 months. Endovascular procedures may be a promising alternative for patients (pts) with haemodynamic impairment, recurrent ischaemic symptoms or symptomatic pseudoaneurysms. Thus, the purpose of this study was to evaluate the efficacy and safety of carotid artery stenting in treatment of selected pts with extracranial ICAD.
This study involved 18 symptomatic pts with the mean age of 44.6 ± 10.4 years with ICAD treated with the use of self-expandable stents. Six months after primary procedures, pts were readmitted to hospital and physical examination followed by cerebral angiography was performed. In the late follow-up period, clinical evaluations completed by duplex Doppler ultrasonography were carried out every 6 months and at the end of the follow-up period.
Nobody died and no life-threatening adverse events were observed during either the in-hospital stay or post-discharge follow-up period (median 21 months). Stent deployment immediately restored flow in the true lumen of ICA in all cases. However, residual blood flow through the false lumen was observed in one pt. Complete resolution of clinical symptoms was observed in 14 pts (78%), partial improvement in 2 (11%) and persistence of neurological deficit in 2 (11%).
Implantation of self-expandable stents in treatment of selected extracranial ICAD cases is safe. This method may enable us to restore immediately and usually permanently proper arterial blood flow in the ICA and in consequence lead to significant clinical improvement in the late follow-up period.
颈内动脉夹层（ICAD）的首选治疗方法是抗凝3至6个月。对于有血流动力学损害、复发性缺血症状或有症状的假性动脉瘤的患者，血管内介入手术可能是一种有前景的替代方法。因此，本研究的目的是评估颈动脉支架置入术治疗选定的颅外ICAD患者的疗效和安全性。
本研究纳入了18例有症状的ICAD患者，平均年龄44.6±10.4岁，采用自膨式支架进行治疗。初次手术后6个月，患者再次入院，进行体格检查，随后进行脑血管造影。在随访后期，每6个月进行一次经颅多普勒超声临床评估，并在随访结束时进行评估。
在住院期间或出院后随访期间（中位时间21个月），无患者死亡，也未观察到危及生命的不良事件。在所有病例中，支架置入立即恢复了颈内动脉真腔内的血流。然而，1例患者观察到假腔内有残余血流。14例患者（78%）临床症状完全缓解，2例（11%）部分改善，2例（11%）神经功能缺损持续存在。
在选定的颅外ICAD病例中植入自膨式支架是安全的。这种方法可能使我们能够立即且通常永久性地恢复颈内动脉正常的动脉血流，从而在随访后期带来显著的临床改善。
