Guo Jianming, Guo Lianrui, Tong Zhu, Wang Zhonggao, Dardik Alan, Gu Yongquan
Department of Vascular Surgery, Xuanwu Hospital, Beijing, China; Capital Medical University, Institute of Vascular Surgery, Capital Medical University, Beijing, China.
Section of Vascular Surgery, Yale University, New Haven, Connecticut; Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, Connecticut.
J Stroke Cerebrovasc Dis. 2018 May;27(5):1296-1301. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.016. Epub 2018 Feb 13.
Patients presenting a carotid stenosis and contralateral carotid occlusion (CCO) have been historically considered at high risk of carotid surgical treatment, and there are few data regarding short-term recovery after stenting therapy in patients with CCO. The aim of this study is to evaluate the short-term recovery and safety of stenting for patients with CCO and different subgroup population.
We retrospectively reviewed the records of consecutive patients with CCO who were treated with stenting endovascular methods between 2008 and 2014. The postoperative outcomes were analyzed according to age, ischemic symptom, cerebral infarction history, and collateral situation subgroups, respectively.
Fifty-eight consecutive patients with CCO were treated and 49 (84.5%) completed a 3-year follow-up. There were significant higher stroke, myocardial infarction, or death events in the aged (≥75 years old) group and poor collateral group (P = .007 and .0024, respectively). There was no difference in the 3-year primary endpoint incidence between the cerebral ischemia symptom subgroups and cerebral infarction history subgroups. Event-free survival, aged group, and poor collateral group were lower (P = .007 and P = .0024, respectively).
Carotid artery stenting (CAS) for patients with common carotid artery is a safe and effective therapy. Factors such as age 75 years or older and poor collateral are associated with a higher 3-year rate of postprocedural stroke, myocardial infarction and death, and lower event-free survival in patients with CCO treated by CAS. Meanwhile, our data do not show a significant impact of cerebral ischemic symptom and cerebral infarction history on clinical outcome of patients with CCO undergoing CAS.
患有颈动脉狭窄和对侧颈动脉闭塞（CCO）的患者历来被认为是颈动脉手术治疗的高危人群，关于CCO患者支架治疗后短期恢复情况的数据很少。本研究的目的是评估CCO患者及不同亚组人群支架治疗的短期恢复情况和安全性。
我们回顾性分析了2008年至2014年间接受血管内支架治疗的连续性CCO患者的记录。分别根据年龄、缺血症状、脑梗死病史和侧支循环情况亚组分析术后结果。
58例连续性CCO患者接受了治疗，49例（84.5%）完成了3年随访。老年（≥75岁）组和侧支循环不良组的卒中、心肌梗死或死亡事件显著更多（分别为P = 0.007和0.0024）。脑缺血症状亚组和脑梗死病史亚组之间3年主要终点发生率无差异。无事件生存率方面，老年组和侧支循环不良组较低（分别为P = 0.007和P = 0.0024）。
对颈总动脉患者进行颈动脉支架置入术（CAS）是一种安全有效的治疗方法。75岁及以上年龄和侧支循环不良等因素与CCO患者接受CAS治疗后3年的术后卒中、心肌梗死和死亡率较高以及无事件生存率较低相关。同时，我们的数据未显示脑缺血症状和脑梗死病史对接受CAS治疗的CCO患者临床结局有显著影响。
