Istituto Auxologico Italiano IRCCS, Department of Surgery, Milan, Italy -
Istituto Auxologico Italiano IRCCS, Laboratory of Research in Vascular Surgery, Milan, Italy -
Int Angiol. 2020 Dec;39(6):485-491. doi: 10.23736/S0392-9590.20.04494-6. Epub 2020 Oct 21.
The aim of this study was to investigate the influence of the aortic arch type on technical and clinical success of carotid artery stenting (CAS) procedure.
Clinical and anatomical data of consecutive patients who underwent CAS from 2010 to 2018 were prospectively collected and retrospectively analyzed. Primary outcome was technical success, define as successful stent delivery and deployment and <30% residual carotid stenosis. Secondary outcomes were death, stroke, myocardial infarction (MI) and transient ischemic attack (TIA) rates at 30 days after CAS. Subgroups analysis with asymptomatic and symptomatic patients were also performed.
During the study period, 523 patients were enrolled and analyzed. Among these, 176 (33.6%) had Type I, 227 (43.4%) had Type II and 120 (23.0%) had Type III or bovine aortic arch (BAA) type. Technical success rate was achieved in 96.0% of cases. At 30 days, if compared with Type I or II, patient with Type III or BAA experienced a higher death rate (0 vs. 0 vs. 1.8%, respectively; P=0.056) and combined postoperative stroke/TIA rate (3% vs. 2.8% vs. 9.9%, respectively; P=0.012). No differences for same outcomes between asymptomatic and symptomatic patients were described, although the latter group experienced more postoperative MI. A multivariate analysis revealed Type III or BAA as an independent risk factor for postoperative stroke/TIA (HR 3.23, IC95% 1.40-7.45; P=0.006).
In this cohort of patients, death and postoperative neurological complications rates were associated with Type III or BAA, irrespective of symptomatic patients' status. Extremely attention is required during perioperative period in patients who were candidate to CAS and with challenging aortic arch anatomy.
本研究旨在探讨主动脉弓类型对颈动脉支架置入术（CAS）技术和临床成功的影响。
前瞻性收集并回顾性分析 2010 年至 2018 年连续接受 CAS 的患者的临床和解剖数据。主要结局是技术成功，定义为支架成功输送和扩张，颈动脉狭窄<30%。次要结局是 CAS 后 30 天的死亡率、卒中和心肌梗死（MI）和短暂性脑缺血发作（TIA）发生率。还对无症状和有症状患者进行了亚组分析。
在研究期间，共纳入 523 例患者进行分析。其中，176 例（33.6%）为 I 型，227 例（43.4%）为 II 型，120 例（23.0%）为 III 型或牛型主动脉弓（BAA）型。96.0%的病例达到技术成功。30 天时，与 I 型或 II 型相比，III 型或 BAA 型患者死亡率（0 比 0 比 1.8%，P=0.056）和联合术后卒中和 TIA 发生率（3%比 2.8%比 9.9%，P=0.012）更高。无症状和有症状患者在上述结局方面无差异，但后者术后 MI 更多。多变量分析显示，III 型或 BAA 是术后卒中和 TIA 的独立危险因素（HR 3.23，95%CI 1.40-7.45；P=0.006）。
在本队列患者中，死亡和术后神经并发症发生率与 III 型或 BAA 相关，与有症状患者的状态无关。对于候选 CAS 且主动脉弓解剖结构具有挑战性的患者，围手术期需要高度关注。
