Rocco Alessandro, Sallustio Fabrizio, Toschi Nicola, Rizzato Barbara, Legramante Jacopo, Ippoliti Arnaldo, Ascoli Marchetti Andrea, Pampana Enrico, Gandini Roberto, Diomedi Marina
Stroke Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Department of Neuroscience, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
J Vasc Interv Radiol. 2018 Sep;29(9):1254-1261.e2. doi: 10.1016/j.jvir.2018.03.025. Epub 2018 Jun 21.
To compare feasibility, 12-month outcome, and periprocedural and postprocedural risks between carotid artery stent (CAS) placement and carotid endarterectomy (CEA) performed within 1 week after transient ischemic attack (TIA) or mild to severe stroke onset in a single comprehensive stroke center.
Retrospective analysis of prospective data collected from 1,148 patients with ischemic stroke admitted to a single stroke unit between January 2013 and July 2015 was conducted. Among 130 consecutive patients with symptomatic carotid stenosis, 110 (10 with TIA, 100 with stroke) with a National Institutes of Health Stroke Scale (NIHSS) score < 20 and a prestroke modified Rankin Scale (mRS) score < 2 were eligible for CAS placement or CEA and treated according to the preference of the patient or a surrogate. Periprocedural (< 48 h) and postprocedural complications, functional outcome, stroke, and death rate up to 12 months were analyzed.
Sixty-two patients were treated with CAS placement and 48 were treated with CEA. Several patients presented with moderate or major stroke (45.8% CEA, 64.5% CAS). NIHSS scores indicated slightly greater severity at onset in patients treated with a CAS vs CEA (6.6 ± 5.7 vs 4.2 ± 3.4; P = .08). Complication rates were similar between groups. mRS scores showed a significant improvement over time and a significant interaction with age in both groups. Similar incidences of death or stroke were shown on survival analysis. A subanalysis in patients with NIHSS scores ≥ 4 showed no differences in complication rate and outcome.
CAS placement and CEA seem to offer early safe and feasible secondary stroke prevention treatments in experienced centers, even after major atherosclerotic stroke.
在单一综合卒中中心，比较短暂性脑缺血发作（TIA）或轻度至重度卒中发作后1周内进行颈动脉支架置入术（CAS）与颈动脉内膜切除术（CEA）的可行性、12个月预后以及围手术期和术后风险。
对2013年1月至2015年7月入住单一卒中单元的1148例缺血性卒中患者收集的前瞻性数据进行回顾性分析。在130例连续的有症状颈动脉狭窄患者中，110例（10例TIA，100例卒中）美国国立卫生研究院卒中量表（NIHSS）评分<20且卒中前改良Rankin量表（mRS）评分<2，符合CAS置入或CEA条件，并根据患者或代理人的意愿进行治疗。分析围手术期（<48小时）和术后并发症、功能预后、卒中以及长达12个月的死亡率。
62例患者接受了CAS置入术，48例患者接受了CEA。部分患者出现中度或重度卒中（CEA组为45.8%，CAS组为64.5%）。NIHSS评分显示，与CEA治疗的患者相比，CAS治疗的患者发病时严重程度略高（6.6±5.7对4.2±3.4；P = 0.08）。两组并发症发生率相似。mRS评分随时间显著改善，且两组均与年龄存在显著交互作用。生存分析显示死亡或卒中发生率相似。对NIHSS评分≥4的患者进行亚组分析，结果显示并发症发生率和预后无差异。
在经验丰富的中心，即使在发生严重动脉粥样硬化性卒中后，CAS置入术和CEA似乎都能提供早期安全可行的二级卒中预防治疗。
