1 Department of Vascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
2 Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
J Endovasc Ther. 2018 Dec;25(6):765-770. doi: 10.1177/1526602818801319. Epub 2018 Oct 9.
To investigate the short-term outcomes and complications of straight vs tapered carotid stent placement for patients with symptomatic carotid stenosis.
A prospective study was conducted to examine if tapered carotid stents (TCS) performed better than straight carotid stents (SCS) in terms of complications and outcomes in patients with a unilateral, symptomatic, internal carotid artery stenosis ⩾70%. Between January 2014 and January 2016, 236 patients were screened; 88 were excluded, leaving 148 patients for 1:1 randomization to carotid artery stenting with either SCS or TCS. The data were analyzed for differences between the groups in terms of complications (hemodynamic depression, cerebral hyperperfusion syndrome, puncture site sequelae) and endpoint events (stroke, myocardial infarction, and death) at 30 days and 6 months.
Two patients in the TCS group underwent endarterectomy after allocation, leaving 72 patients (mean age 65.1±8.8 years; 59 men) in the TCS group for analysis vs 74 (mean age 65.0±7.9 years; 58 men) in the SCS group. The technical success was 100% in both groups. The incidence of hemodynamic depression (hypotension and bradycardia) after the procedures were higher in the SCS group (p=0.04), and the patients who underwent SCS procedures had longer hospital stays (p=0.01). There was no difference in the incidences of complications, myocardial infarction, mortality, or stroke at 30 days or 6 months between the SCS and TCS groups. The rates of restenosis (4% SCS vs 1% TCS) were similar (p=0.63); all restenoses were moderate (50%-70%).
When compared to straight stents, tapered carotid stents significantly decreased hemodynamic complications and hospital stay.
研究症状性颈动脉狭窄患者使用直型颈动脉支架与锥形颈动脉支架置入的短期结果和并发症。
进行了一项前瞻性研究，以检查在单侧、症状性、内颈动脉狭窄≥70%的患者中，锥形颈动脉支架（TCS）在并发症和结局方面是否优于直型颈动脉支架（SCS）。2014 年 1 月至 2016 年 1 月，筛选了 236 例患者；排除 88 例，148 例患者被随机分为 1:1 组，分别接受 SCS 或 TCS 颈动脉支架置入。分析两组之间在 30 天和 6 个月时的并发症（血流动力学抑制、高灌注综合征、穿刺部位后遗症）和终点事件（中风、心肌梗死和死亡）方面的差异。
TCS 组有 2 例患者在分配后接受了内膜切除术，TCS 组有 72 例（平均年龄 65.1±8.8 岁；59 例男性）纳入分析，SCS 组有 74 例（平均年龄 65.0±7.9 岁；58 例男性）。两组的技术成功率均为 100%。SCS 组术后发生血流动力学抑制（低血压和心动过缓）的发生率较高（p=0.04），且 SCS 组患者的住院时间较长（p=0.01）。两组在 30 天和 6 个月时的并发症、心肌梗死、死亡率或中风发生率无差异。SCS 组和 TCS 组的再狭窄率（4% SCS 与 1% TCS）相似（p=0.63）；所有再狭窄均为中度（50%-70%）。
与直型支架相比，锥形颈动脉支架显著降低了血流动力学并发症和住院时间。
