Mayoral Campos Victoria, Guirola Órtiz José Andrés, Tejero Juste Carlos, Gimeno Peribáñez María José, Serrano Carolina, Pérez Lázaro Cristina, de Blas Giral Ignacio, de Gregorio Ariza Miguel Ángel
1GITMI (Grupo de Investigación en Tecnicas de Minima Invasión) del Gobierno de Aragon, Zaragoza, Spain.
2Servicio de Radiología intervencionista, Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco 15, 50009 Zaragoza, Spain.
CVIR Endovasc. 2018;1(1):3. doi: 10.1186/s42155-018-0008-2. Epub 2018 Jul 17.
Revascularization with carotid stent (CAS) is considered the therapeutic alternative to endarterectomy (CEA). However, its role compared to CEA remains questioned, mainly due of the heterogeneity of long-term results. The objective of this study was to report the efficacy and durability of CAS in terms of stroke prevention in a "real world experience".
This was a single-center retrospective analysis of 344 patients treated with CAS between January 2001 and December 2015.The primary outcome of the trial was stroke, myocardial infarction, or death during a periprocedural period or any stroke event over a 15-year follow-up. The secondary aim was to identify risk factors for 30-day complications, long-term neurological complications, and intra-stent restenosis.
The primary composite end point (any stroke, myocardial infarction, or death during the periprocedural period) was 2.3%. The use of an EPD was protective against major complications.Long-term follow-up was achieved in 294 patients (85,5%) with a median of 50 months (range 0-155 months). Fifty-six (16,3%) died within this period, most commonly of nonvascular causes (4 patients had stroke-related deaths). During the follow-up period, 8 strokes and 3 TIAs were diagnosed (3.2%).ISR determined by sequential ultrasound was assessed in 4.4% of the patients and remained asymptomatic in all but 2 patients (0.6%). All patients with restenosis underwent revascularization with balloon angioplasty.
The long-term follow-up results of our study validate CAS as a safe and durable procedure with which to prevent ipsilateral stroke, with an acceptable rate of restenosis, recurrence and mortality.
颈动脉支架血管成形术（CAS）被认为是动脉内膜切除术（CEA）的治疗替代方案。然而，与CEA相比，其作用仍受到质疑，主要是由于长期结果的异质性。本研究的目的是在“真实世界经验”中报告CAS在预防卒中方面的疗效和持久性。
这是一项对2001年1月至2015年12月期间接受CAS治疗的344例患者的单中心回顾性分析。该试验的主要结局是围手术期卒中、心肌梗死或死亡，或15年随访期间的任何卒中事件。次要目的是确定30天并发症、长期神经并发症和支架内再狭窄的危险因素。
主要复合终点（围手术期任何卒中、心肌梗死或死亡）为2.3%。使用脑保护装置可预防主要并发症。294例患者（85.5%）获得长期随访，中位随访时间为50个月（范围0 - 155个月）。在此期间，56例（16.3%）死亡，最常见的是非血管原因（4例死于与卒中相关的原因）。随访期间，诊断出8例卒中及3例短暂性脑缺血发作（TIA）（3.2%）。4.4%的患者通过连续超声评估了支架内再狭窄，除2例患者（0.6%）外，其余均无症状。所有再狭窄患者均接受了球囊血管成形术进行血管再通。
我们研究的长期随访结果证实CAS是一种安全且持久的预防同侧卒中的手术，再狭窄、复发和死亡率均可接受。
