AbuRahma Ali F
Department of Surgery, West Virginia University, Charleston, West Virginia, USA.
Ann Vasc Dis. 2018 Mar 25;11(1):15-24. doi: 10.3400/avd.ra.17-00136.
Carotid artery stenting (CAS) has been recommended as an alternative treatment to carotid endarterectomy for patients with significant carotid stenosis. Only a few studies have analyzed clinical/anatomical and technical variables that affect perioperative outcomes of CAS. Following a comprehensive Medline search, it was reported that clinical factors, including age of >80 years, chronic renal failure, diabetes mellitus, symptomatic indications, and procedures performed within 2 weeks of transient ischemic attack symptoms, are associated with high perioperative stroke and death rates. They also highlighted that angiographic variables, e.g., ulcerated and calcified plaques, left carotid intervention, >90% stenosis, >10-mm target lesion length, ostial involvement, type III aortic arch, and >60°-angulated internal carotid and common carotid arteries, are predictors of increased stroke rates. Technical factors associated with increased perioperative risk of stroke include percutaneous transluminal angioplasty (PTA) without embolic protection devices, PTA before stent placement, and the use of multiple stents. This review describes the most widely quoted data in defining various predictors of perioperative stroke and death after CAS. (This is a review article based on the invited lecture of the 45th Annual Meeting of Japanese Society for Vascular Surgery.).
对于有严重颈动脉狭窄的患者，颈动脉支架置入术（CAS）已被推荐为颈动脉内膜切除术的替代治疗方法。仅有少数研究分析了影响CAS围手术期结果的临床/解剖学和技术变量。在全面检索Medline之后，有报道称临床因素，包括年龄大于80岁、慢性肾功能衰竭、糖尿病、有症状指征以及在短暂性脑缺血发作症状出现后2周内进行手术，均与围手术期高卒中率和死亡率相关。他们还强调血管造影变量，例如溃疡和钙化斑块、左侧颈动脉干预、狭窄程度>90%、目标病变长度>10mm、开口处受累、III型主动脉弓以及颈内动脉和颈总动脉成角>60°，是卒中率增加的预测因素。与围手术期卒中风险增加相关的技术因素包括未使用栓子保护装置的经皮腔内血管成形术（PTA）、支架置入前的PTA以及使用多个支架。本综述描述了在定义CAS术后围手术期卒中和死亡的各种预测因素时最常被引用的数据。（这是一篇基于日本血管外科学会第45届年会特邀讲座的综述文章。）
