Department of Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy -
Laboratory of Research in Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy -
Int Angiol. 2021 Apr;40(2):87-96. doi: 10.23736/S0392-9590.20.04525-3. Epub 2020 Dec 4.
In the current literature, correlations between a contralateral carotid artery occlusion (CCO) with mortality and major adverse cardiac or cerebrovascular events (MACCE) rates after carotid artery stenting (CAS) are often described with controversial conclusions. Moreover, long-term results of mortality, MACCE and restenosis rate are scarcely reported. This study examined the association between a CCO and the short- and long-term outcomes after CAS.
One hundred and forty-six patients with CCO and without (No-CCO) who underwent between 2010 and 2017 to a CAS procedure in a single institution were retrospectively evaluated. The primary aim of the study was to evaluate mortality and MACCE rates in the short-term (defined as the occurrence during hospitalization and within 30-day) and after 3-year follow-up. The secondary aim of the study was to examine the restenosis rates in the short- and long-term period.
The overall success of CAS was 99.3% and the 30-day all-cause mortality rate was 0.7% (one death). About MACCE, there were no major strokes in the CCO groups and 1 (1.4%) in the No-CCO group (P=1.00). The rate of 30-day minor strokes was 1.4% (1 patient) in the CCO group and 2.7% (2 patients) in the No-CCO group (P=1.00). In the 3-year follow-up, death occurred in 11 CCO vs. 6 No-CCO patients, respectively (15.1% vs. 8.2%, P=0.30). Regarding MACCE, major stroke occurred in 6 CCO vs. 2 No-CCO patients (8.2% vs. 2.7%, P=0.27), minor stroke in 6 CCO vs. 6 No-CCO (8.2% vs. 8.2%, P=1.0) and myocardial infarction in 6 CCO (8.2%) vs. 3 No-CCO patients (8.2 vs. 4.1%, P=0.49), respectively. Regarding the 30-day restenosis rate, it was observed in one patient (1.4%) in the CCO group while no cases were recorded in the No-CCO group, respectively (P=1.00). In the 3-year follow-up, greater than >50% restenosis was observed in 7 patients (9.6%) in the CCO group and in one patient (1.4%) in the No-CCO group (P=0.06), respectively. Kaplan-Meier survival analysis revealed that CCO patients had a lower 3-year freedom from restenosis rate with respect to the No-CCO group (87.6% vs. 98.6%, P=0.024). A Cox regression model on 3-year restenosis highlighted female gender and hypertension to be statistically significant predictors of restenosis.
Patients with a preexisting CCO did not show a significative increased risk of procedural adverse events after CAS both in the immediate and long-term follow-up, but on the long term they are more likely to experience restenosis. CCO condition should be considered always as a clinical manifestation of a more aggressive carotid atherosclerosis.
在当前的文献中，关于颈动脉支架置入术（CAS）后，对侧颈动脉闭塞（CCO）与死亡率和主要心脑血管不良事件（MACCE）发生率之间的相关性，往往存在相互矛盾的结论。此外，关于死亡率、MACCE 和再狭窄率的长期结果报道甚少。本研究旨在探讨 CCO 与 CAS 后短期和长期结局之间的关系。
回顾性分析了 2010 年至 2017 年期间在我院行 CAS 治疗的 146 例 CCO 患者（CCO 组）和未发生 CCO 的患者（No-CCO 组）。本研究的主要目的是评估短期（住院期间和 30 天内）和 3 年随访时的死亡率和 MACCE 发生率。本研究的次要目的是观察短期和长期的再狭窄率。
CAS 的总体成功率为 99.3%，30 天全因死亡率为 0.7%（1 例死亡）。关于 MACCE，CCO 组无重大卒中，No-CCO 组有 1 例（1.4%）（P=1.00）。CCO 组 30 天内小卒中发生率为 1.4%（1 例），No-CCO 组为 2.7%（2 例）（P=1.00）。在 3 年随访中，CCO 组有 11 例死亡，No-CCO 组有 6 例死亡（15.1%比 8.2%，P=0.30）。关于 MACCE，CCO 组有 6 例发生大卒中，No-CCO 组有 2 例（8.2%比 2.7%，P=0.27），CCO 组有 6 例发生小卒中，No-CCO 组有 6 例（8.2%比 8.2%，P=1.0），CCO 组有 6 例发生心肌梗死，No-CCO 组有 3 例（8.2%比 4.1%，P=0.49）。关于 30 天再狭窄率，CCO 组有 1 例（1.4%），No-CCO 组无再狭窄（P=1.00）。在 3 年随访中，CCO 组有 7 例（9.6%）发生>50%的再狭窄，No-CCO 组有 1 例（1.4%）（P=0.06）。Kaplan-Meier 生存分析显示，CCO 组患者 3 年免于再狭窄的可能性低于 No-CCO 组（87.6%比 98.6%，P=0.024）。Cox 回归模型分析显示，女性和高血压是 3 年内再狭窄的统计学显著预测因素。
在 CAS 治疗的即刻和长期随访中，患有预存 CCO 的患者并未显示出明显增加的不良事件风险，但长期来看，他们更有可能发生再狭窄。CCO 应被视为更具侵袭性的颈动脉粥样硬化的临床表现。
