Liang Patric, Wu Winona W, Schermerhorn Marc L
Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA -
J Cardiovasc Surg (Torino). 2019 Jun;60(3):345-353. doi: 10.23736/S0021-9509.19.10922-6. Epub 2019 Mar 4.
Transfemoral carotid stenting has struggled to become a suitable alternative to carotid endarterectomy for the treatment of carotid disease because of higher perioperative stroke risks, even with use of embolic protection devices. To reduce the perioperative stroke rates associated with carotid stenting, several advancements in stent design, embolic protection systems, and technical approaches have been developed. Transcarotid artery revascularization (TCAR) was also recently introduced as a novel carotid artery stenting option which circumvents several of the high embolic-risk maneuvers found in transfemoral carotid stenting and employs a flow reversal system that provides continuous embolic protection throughout the procedure. Early results from this technique have shown low stroke/death rates comparable to carotid endarterectomy while maintaining the minimally invasive benefits of carotid stenting. TCAR has a strong potential to become the preferred method of carotid stenting in the near future and may challenge carotid endarterectomy as the preferred carotid artery revascularization method.
由于围手术期中风风险较高，即使使用了栓子保护装置，经股动脉颈动脉支架置入术一直难以成为治疗颈动脉疾病的合适替代颈动脉内膜切除术的方法。为了降低与颈动脉支架置入术相关的围手术期中风发生率，在支架设计、栓子保护系统和技术方法方面已经取得了一些进展。经颈动脉血管重建术（TCAR）最近也作为一种新型的颈动脉支架置入选择被引入，它规避了经股动脉颈动脉支架置入术中发现的一些高栓塞风险操作，并采用了一种血流逆转系统，在整个手术过程中提供持续的栓子保护。这项技术的早期结果显示，其低中风/死亡率与颈动脉内膜切除术相当，同时保持了颈动脉支架置入术的微创优势。TCAR在不久的将来很有可能成为颈动脉支架置入术的首选方法，并可能挑战颈动脉内膜切除术作为首选的颈动脉血管重建方法的地位。
