Juergen Kammler, Hermann Blessberger, Michael Lichtenauer, Thomas Lambert, Joerg Kellermair, Alexander Nahler, Stefan Schwarz, Christian Reiter, Michael Grund, Alexander Kypta, Clemens Steinwender
Department of Cardiology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria.
Heart Vessels. 2017 Oct;32(10):1169-1174. doi: 10.1007/s00380-017-0986-3. Epub 2017 May 4.
CAS has emerged as an alternative to carotid endarterectomy for the treatment of significant carotid artery stenosis. We investigated if the side of the stenosis treated has an influence on the neurological outcome of our patients. CAS was performed in 1124 patients at our center. The left carotid artery (group L) was intervened in 557 and the right carotid artery (group R) in 567 patients. Data of both patient groups were analyzed with respect to the total rate of peri-interventional ischemic cerebral events, defined as transient ischemic attacks, minor and major strokes, respectively. The total peri-interventional ischemic cerebral event rate was 10.1% in group L and 6.7% in group R (p = 0.042), respectively. The routine use of a filter wire resulted in a significant reduction of complication rates in group L (from 14.7 to 7.1%; p = 0.005) but not in group R (from 7.8 to 6.0%; p = 0.505). Ischemic cerebral events did not differ between group L and R, when only patients in whom a filter wire was used were analyzed (7.1% in group L and 6.0% in group R, p = 0.174). Peri-interventional ischemic cerebral complication rates in patients undergoing CAS differ with respect to the side treated. This may be due to a more frequent plaque mobilization caused by the guiding catheter.
颈动脉血管成形术（CAS）已成为治疗严重颈动脉狭窄的颈动脉内膜切除术的替代方法。我们研究了所治疗狭窄的侧别是否会对我们患者的神经学预后产生影响。我们中心对1124例患者实施了CAS。其中557例干预左侧颈动脉（L组），567例干预右侧颈动脉（R组）。分析了两组患者围手术期缺血性脑事件的总发生率，围手术期缺血性脑事件分别定义为短暂性脑缺血发作、轻度和重度卒中。L组围手术期缺血性脑事件总发生率为10.1%，R组为6.7%（p = 0.042）。常规使用滤网导丝使L组并发症发生率显著降低（从14.7%降至7.1%；p = 0.005），但R组未降低（从7.8%降至6.0%；p = 0.505）。仅分析使用滤网导丝的患者时，L组和R组的缺血性脑事件无差异（L组为7.1%，R组为6.0%，p = 0.174）。接受CAS治疗的患者围手术期缺血性脑并发症发生率因治疗的侧别而异。这可能是由于引导导管导致斑块移动更频繁所致。
