[放射性颈动脉狭窄：一种个性化治疗方法]

[Radiation-induced carotid stenosis: A personnalized approach].

作者信息

Gaudry M, David B, Omnes V, Bal L, De Masi M, Bartoli J M, Piquet P

机构信息

Service de chirurgie vasculaire, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France.

出版信息

J Med Vasc. 2017 Oct;42(5):263-271. doi: 10.1016/j.jdmv.2017.06.001. Epub 2017 Sep 13.

DOI:10.1016/j.jdmv.2017.06.001

PMID:28964385

Abstract

INTRODUCTION

Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical).

METHODS

We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms.

RESULTS

RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group.

CONCLUSION

Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.

摘要

引言

放射性颈动脉狭窄（RICS）的外科治疗具有挑战性，且局部并发症风险较高。颈动脉支架置入术（CAS）可能是一种合适的替代方法。最佳治疗方法尚未明确。我们回顾了根据更合适的特征（解剖学和临床特征）选择的两种技术的治疗结果。

方法

我们回顾性分析了2008年至2015年间接受颈动脉干预的1230例患者中38例接受43次RICS治疗的患者（5例双侧病变）。主要终点是30天时的发病率和死亡率（短暂性脑缺血发作、中风、心肌梗死或死亡）。次要终点是技术成功率、伤口并发症、颅神经损伤（CNI）、再狭窄（≥50%）和复发症状。

结果

手术组6例患者和CAS组3例患者的RICS有症状。手术组的病变更长（P=0.02）且钙化更严重（P=0.08）。技术成功率为100%。颅神经损伤率为14.2%（3/21）。所有损伤在几周内完全恢复。在CAS组中，技术成功率为95%（21/22），1例失败是由于残余狭窄超过30%。手术组和CAS组围手术期卒中发生率分别为0%和4.5%（0/21对1/22，P=0.32）。无早期死亡病例。平均随访19.1个月（3-75个月）。手术组再狭窄率为9.5%（2/21），CAS组为9%（2/22）。