Jiang Xiong-Jing, Dong Hui, Peng Meng, Zou Yu-Bao, Song Lei, Xu Bo, Zhang Hui-Min, Wu Hai-Ying, Zhou Xian-Liang, Yang Yue-Jin, Gao Run-Lin
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Endovasc Ther. 2016 Apr;23(2):258-66. doi: 10.1177/1526602815626900. Epub 2016 Jan 28.
To evaluate clinical outcomes of simultaneous bilateral carotid artery stenting (sbCAS) compared with unilateral CAS (uCAS).
The database in our institution was queried to identify all patients treated with CAS from January 2005 to December 2012. In this time frame, 120 (18.8%) patients (mean age 64.9 ± 7.7 years; 96 men) underwent sbCAS and 517 (81.2%) patients (mean age 65.7 ± 7.7 years; 421 men) received uCAS. The primary endpoint was the composite of stroke, myocardial infarction, or death within 30 days or any ipsilateral stroke within 1 year.
There was no significant difference in the rates of the primary endpoint between the sbCAS and uCAS groups (6.7% vs 4.6%, p=0.358). The rates of the primary endpoint among symptomatic patients was 8.0% in the sbCAS group and 5.0% in the uCAS group (p=0.299) and 3.1% and 4.0%, respectively (p=0.821) among asymptomatic patients. During the 30-day periprocedural period, the rates of the primary endpoint did not differ significantly between the sbCAS and uCAS groups among all patients (5.8% vs 4.4%, p=0.479), symptomatic patients (6.8% vs 5.0%, p=0.594), or asymptomatic patients (3.1% vs 3.5%, p>0.999). After this period, the incidences of any ipsilateral stroke were similarly low (0.8% and 0.2%, respectively; p=0.342).
The study showed that simultaneous bilateral CAS had no more adverse events than unilateral CAS during the periprocedural period or within 1 year. This 1-stage strategy may become a valuable alternative in the treatment of patients with severe bilateral carotid stenosis.
评估同期双侧颈动脉支架置入术（sbCAS）与单侧颈动脉支架置入术（uCAS）的临床疗效。
查询本机构数据库，以确定2005年1月至2012年12月期间所有接受颈动脉支架置入术治疗的患者。在此时间段内，120例（18.8%）患者（平均年龄64.9±7.7岁；96例男性）接受了sbCAS，517例（81.2%）患者（平均年龄65.7±7.7岁；421例男性）接受了uCAS。主要终点为30天内发生的卒中、心肌梗死或死亡的复合事件，或1年内发生的任何同侧卒中。
sbCAS组和uCAS组主要终点发生率无显著差异（6.7%对4.6%，p = 0.358）。有症状患者中，sbCAS组主要终点发生率为8.0%，uCAS组为5.0%（p = 0.299）；无症状患者中，该发生率分别为3.1%和4.0%（p = 0.821）。在围手术期30天内，sbCAS组和uCAS组所有患者（5.8%对4.4%，p = 0.479）、有症状患者（6.8%对5.0%，p = 0.594）或无症状患者（3.1%对3.5%，p>0.999）的主要终点发生率均无显著差异。在此期间之后，任何同侧卒中的发生率同样较低（分别为0.8%和0.2%；p = 0.342）。
研究表明，同期双侧颈动脉支架置入术在围手术期或1年内的不良事件并不比单侧颈动脉支架置入术多。这种一期治疗策略可能成为治疗双侧严重颈动脉狭窄患者的一种有价值的替代方法。
