Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Interv Neuroradiol. 2021 Jun;27(3):411-418. doi: 10.1177/1591019920977552. Epub 2020 Dec 6.
Carotid artery stenting (CAS) has increasingly emerged as an alternative strategy to carotid endarterectomy in the treatment of patients with symptomatic carotid stenosis. Optimal timing for CAS after symptoms onset remains unclear. We aimed to evaluate the safety and efficacy of CAS when performed in an emergency setting.
We performed a retrospective analysis of CAS patients admitted to our CSC with symptomatic extracranial carotid occlusion or significant stenosis from January 2014-September 2019. Emergency CAS was defined as CAS performed during the same hospitalization from TIA/stroke onset, whereas elective CAS as CAS performed on a subsequent admission. The primary outcome was defined as the occurrence of any stroke, myocardial infarction, or death related to the procedure at 3 months of follow-up. Secondary outcomes included periprocedural complications and the rate of restenosis/occlusion at follow-up. Logistic regression and survival analyses were used to compare outcomes and restenosis at follow-up.
We identified 75 emergency and 104 elective CAS patients. Emergency CAS patients had significantly higher rates of ipsilateral carotid occlusion (17% vs. 2%, p < 0.001) and use of general anesthesia (19% vs. 4%, p = 0.001) than elective CAS. There were no significant differences between emergency and elective CAS in the primary (5.7% vs. 1%, p = 0.161) and secondary (9% vs. 4.8%, p = 0.232) outcomes. We did not find differences in the rate of restenosis/occlusion (7% vs. 11.6%; log-rank test p = 0.3) at a median of 13 months follow-up.
In our study, emergency CAS in symptomatic patients might have a similar safety and efficacy profile to elective CAS at 3 months and long-term follow-up.
在治疗有症状的颈动脉狭窄患者中，颈动脉支架置入术（CAS）已逐渐成为颈动脉内膜切除术的替代策略。CAS 的最佳时机仍不清楚。我们旨在评估在紧急情况下进行 CAS 的安全性和疗效。
我们对 2014 年 1 月至 2019 年 9 月因症状性颅外颈动脉闭塞或严重狭窄而入住我们 CSC 的 CAS 患者进行了回顾性分析。紧急 CAS 定义为从 TIA/中风发作到住院期间进行的 CAS，而择期 CAS 定义为在随后的住院期间进行的 CAS。主要结局定义为在 3 个月随访期间与手术相关的任何中风、心肌梗死或死亡。次要结局包括围手术期并发症和随访期间的再狭窄/闭塞率。使用逻辑回归和生存分析比较结局和随访期间的再狭窄率。
我们确定了 75 例紧急和 104 例择期 CAS 患者。紧急 CAS 患者同侧颈动脉闭塞（17% vs. 2%，p < 0.001）和全身麻醉使用率（19% vs. 4%，p = 0.001）明显高于择期 CAS 患者。紧急 CAS 和择期 CAS 在主要（5.7% vs. 1%，p = 0.161）和次要（9% vs. 4.8%，p = 0.232）结局方面无显著差异。在中位数为 13 个月的随访中，我们没有发现再狭窄/闭塞率（7% vs. 11.6%；对数秩检验 p = 0.3）的差异。
在我们的研究中，症状性患者的紧急 CAS 在 3 个月和长期随访时可能具有与择期 CAS 相似的安全性和疗效。
