İnanç Yılmaz, İnanç Yusuf
Department of Neurology, Sütçüimam University School of Medicine, Kahramanmaraş, Turkey.
Department of Neurology, Gaziantep University School of Medicine, Gaziantep, Turkey.
Noro Psikiyatr Ars. 2018 Aug 3;57(2):85-88. doi: 10.29399/npa.23239. eCollection 2020 Jun.
Treatment strategy for near-occlusions (NO) of the internal carotid artery (ICA) is still controversial. In this study, we aimed to present the clinical results of stent placement in 50 patients with carotid artery (NO) stenosis that presented to our center, and upon which revascularization will be performed.
Between 2014 and 2017, 50 patients with (NO) from 180 patients who had stents in the Interventional Vascular Neurology clinic were retrospectively studied. All the patients whether using or not using the proximal and distal protection device during the procedure were included. Patients had clinical neurologic evaluation, and underwent carotid artery radiologic imaging before the carotid artery stent (CAS) procedure. Balloon dilatation was applied before the stent procedure for patients that had advanced stenosis. Post-dilatation was applied with a balloon of appropriate size in case of residual narrowing. Findings such as bradycardia, hypotension, reperfusion hemorrhage during and after the stent placement procedure, as well as patients that developed restenosis within 12 months were recorded.
This study includes 50 (30 males, 20 females) patients that underwent carotid stent placement. The mean age of patients was 65 (28-81). Reperfusion hemorrhage was seen in 1 (2%) patient and the patient died in week 3. Ten (20%) patients complained of chills and tremor lasting less than 3 hours after the procedure. One (2%) patient had encephalopathy and agitation for less than 24 hours. Two (4%) patients had hypotension, and 15 (30%) patients had a headache for less than 24 hours. Three patients developed local hematoma at the site of the sheath, and were treated by applying compression. Restenosis signs in the stent site was observed in 6 patients (12%) in color Doppler ultrasonography of the carotid performed in the 6th and 12th months.
Although the innate process of ICA NO is not well known, it might be more frequent than currently considered. Especially after the diagnosis of ICA stenosis, it is important to make the right diagnosis in patients that have new ipsilateral symptoms. After the diagnosis is made, CAS, when performed by an experienced neuro-interventional team, seems beneficial with low complication rates.
颈内动脉（ICA）近闭塞（NO）的治疗策略仍存在争议。在本研究中，我们旨在呈现50例就诊于我院且拟行血运重建的颈动脉（NO）狭窄患者支架置入的临床结果。
回顾性研究2014年至2017年间介入血管神经病学门诊180例置入支架患者中的50例（NO）患者。所有患者均纳入研究，无论其在手术过程中是否使用近端和远端保护装置。患者在颈动脉支架（CAS）手术前进行临床神经学评估，并接受颈动脉放射影像学检查。对于重度狭窄患者，在支架手术前进行球囊扩张。若存在残余狭窄，则使用合适尺寸的球囊进行后扩张。记录支架置入过程中及术后的心动过缓、低血压、再灌注出血等情况，以及在12个月内发生再狭窄的患者。
本研究纳入50例（30例男性，20例女性）接受颈动脉支架置入的患者。患者平均年龄为65岁（28 - 81岁）。1例（2%）患者出现再灌注出血，该患者于第3周死亡。10例（20%）患者术后出现寒战和震颤，持续时间少于3小时。1例（2%）患者出现脑病和躁动，持续时间少于24小时。2例（4%）患者出现低血压，15例（30%）患者出现头痛，持续时间少于24小时。3例患者在鞘管置入部位出现局部血肿，通过压迫进行治疗。在第6个月和第12个月进行的颈动脉彩色多普勒超声检查中，6例（12%）患者在支架部位观察到再狭窄迹象。
尽管ICA NO的内在过程尚不清楚，但可能比目前认为的更为常见。特别是在诊断为ICA狭窄后，对于出现新的同侧症状的患者进行正确诊断很重要。诊断明确后，由经验丰富的神经介入团队进行CAS手术似乎有益，且并发症发生率较低。
