Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Jan 1;84(1):87-94. doi: 10.1097/JCMA.0000000000000405.
Stent patency after carotid angioplasty and stenting (CAS) correlates not only with stroke prevention but also with improvements in cognition and quality of life by positively influencing cerebral perfusion. The long-term outcomes of CAS after more than 5 years have still not been well described. This retrospective study was designed to evaluate the stent patency and significant restenosis (SR) after CAS with more than 5 years of follow-up.
Between 2006 and 2012, 118 patients with carotid stenosis who underwent 131 CAS procedures with regular annual imaging follow-up for more than 5 years were enrolled. We evaluated their demographic characteristics and the risk factors related to stent restenosis. Patients with SR (restenosis ≥ 50%) were compared with those with no significant restenosis (NSR, patency or restenosis < 50%) to identify the restenosis predictors and restenosis-free survival.
Of the 131 CAS procedures, 16.0% (21/131) had SR. A history of head and neck radiotherapy (HNRT) was a predictor for SR (HR, 6.352; 95% CI, 2.504-16.112; p < 0.001) and was associated with shorter restenosis-free survival (log-rank test p value < 0.001, median time of restenosis-free survival was 38 months). Left-sided stenting was an associated factor for SR (HR, 3.007; 95% CI, 1.068-8.467; p = 0.037) with a trend of less restenosis-free survival (log-rank test p value 0.067).
Both HNRT and left-sided carotid stenosis were predictors of SR after CAS in more than 5 years of long-term follow-up. Restenosis-free survival was significantly shorter in patients with prior HNRT than in patients without previous irradiation treatment. We suggest close follow-up and aggressive medical treatment for patients with prior HNRT and left-sided carotid stenosis undergoing CAS.
颈动脉血管成形术和支架置入术（CAS）后的支架通畅率不仅与预防中风有关，而且通过积极影响脑灌注还可改善认知功能和生活质量。然而，超过 5 年的 CAS 长期结果仍未得到很好的描述。本回顾性研究旨在评估超过 5 年随访期的 CAS 后的支架通畅率和显著再狭窄（SR）。
在 2006 年至 2012 年间，我们招募了 118 名颈动脉狭窄患者，他们接受了 131 例 CAS 手术，并进行了超过 5 年的定期年度影像学随访。我们评估了他们的人口统计学特征和与支架再狭窄相关的危险因素。将 SR（再狭窄≥50%）患者与无显著再狭窄（NSR，通畅或再狭窄<50%）患者进行比较，以确定再狭窄的预测因素和无再狭窄生存率。
在 131 例 CAS 手术中，有 16.0%（21/131）发生了 SR。头颈部放疗（HNRT）史是 SR 的预测因素（HR，6.352；95%CI，2.504-16.112；p<0.001），并与较短的无再狭窄生存率相关（log-rank 检验 p 值<0.001，无再狭窄生存率的中位时间为 38 个月）。左侧支架置入是 SR 的相关因素（HR，3.007；95%CI，1.068-8.467；p=0.037），且无再狭窄生存率呈下降趋势（log-rank 检验 p 值 0.067）。
在超过 5 年的长期随访中，HNRT 和左侧颈动脉狭窄均是 CAS 后 SR 的预测因素。与未接受过放疗的患者相比，有 HNRT 史的患者无再狭窄生存率显著缩短。对于接受过 HNRT 和左侧颈动脉狭窄的 CAS 患者，我们建议密切随访并积极进行药物治疗。
