de Waard D D, Halliday A, de Borst G J, Bulbulia R, Huibers A, Casana R, Bonati L H, Tolva V
Nuffield Department of Surgical Sciences, University of Oxford, Level 6 John Radcliffe Hospital, Oxford OX3 9DU, UK; Department of Vascular Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht, The Netherlands.
Nuffield Department of Surgical Sciences, University of Oxford, Level 6 John Radcliffe Hospital, Oxford OX3 9DU, UK.
Eur J Vasc Endovasc Surg. 2017 May;53(5):617-625. doi: 10.1016/j.ejvs.2016.12.034. Epub 2017 Mar 11.
OBJECTIVE/BACKGROUND: Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics.
Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90-99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed.
In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90-99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics.
In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.
目的/背景：颈动脉支架置入术（CAS）期间或术后不久，一些斑块和病变特征与手术中风风险增加相关。虽然支架设计和脑保护装置（CPD）的技术进步可能有助于降低手术中风风险，且解剖结构仍然很重要，但根据斑块和病变特征调整支架置入手术可能是降低与CAS相关中风的有用策略。在这份关于正在进行的无症状颈动脉手术试验-2（ACST-2）的描述性报告中，评估了支架的选择以及CPD的使用或类型是否受斑块和病变特征的影响。
本研究纳入了2008年至2015年间接受CAS的试验患者。采用卡方统计分析斑块回声、同侧闭塞前病变（90-99%）以及对侧严重狭窄（>50%）或颈动脉闭塞对介入医生选择支架和CPD的影响。还分析了不同专业之间治疗偏好的差异。
本研究纳入了来自88个ACST-2中心的831例患者。几乎所有手术均由介入放射科医生（50%）或血管外科医生（45%）进行。斑块回声、同侧闭塞前病变（90-99%）以及对侧严重狭窄（>50%）或闭塞并不影响支架的选择，也不影响脑保护的使用及所采用CPD的类型（即过滤器/血流逆转）。血管外科医生使用CPD的频率显著高于介入放射科医生（98.6%对76.3%；p<0.001），但这种选择似乎并不取决于患者特征。
在ACST-2中，斑块特征和狭窄严重程度并非主要决定介入医生对支架的选择或CPD的使用及类型，这表明其他因素，如血管解剖结构或个人及中心偏好，可能更为重要。在参与研究的欧洲各中心，支架和CPD的使用存在高度异质性。
