Latacz Paweł, Simka Marian, Krzanowski Marcin, Krzanowska Katarzyna, Brzegowy Paweł, Łasocha Bartłomiej, Popiela Tadeusz J
Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
Department of Anatomy, University of Opole, Opole, Poland.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):175-182. doi: 10.5114/wiitm.2020.94519. Epub 2020 Apr 20.
Although filters are still preferred during carotid stenting, proximal protection systems (PPS) are increasingly used during these procedures. PPS seem to be safer than distal systems, especially in symptomatic patients, but evidence supporting their use is limited.
This was a post hoc survey with 30-day mid-term and long-term follow up, which was aimed at assessment of the safety and efficacy of stenting of the internal carotid artery under PPS in symptomatic patients.
We analysed the results of stenting in 120 symptomatic patients presenting with at least 60% stenosis. Patients were aged 67.9 ±9.8 years, and 12 patients were older than 80 years. An occlusion of contralateral artery was found in 5 patients and bilateral stenosis in 26 patients. The primary endpoint of this study was the proportion of patients who had new neurological events, including transient ischemic attack and minor or major stroke in 30-day follow-up. The secondary endpoint was a composite of technical and clinical success. During long-term follow-up we assessed new neurological events and stenoses of implanted stents.
The incidence of new neurological events during 30-day follow-up was 0.8%. The rate of technical success defined by secondary endpoint was 100%. Mean internal carotid artery stenosis before and after stent implantation was 93.8 ±9% and 8.4 ±6.3%, respectively (p < 0.001). Procedural success was achieved in all cases. During long-term follow-up there were two (1.7%) asymptomatic in-stent stenoses and no (0%) new neurological events.
Endovascular management of symptomatic carotid stenosis under PPS is safe, feasible, and appears to be a good alternative to surgical endarterectomy.
尽管在颈动脉支架置入术中仍更倾向于使用滤网，但近端保护系统（PPS）在这些手术中的使用越来越多。PPS似乎比远端系统更安全，尤其是在有症状的患者中，但支持其使用的证据有限。
这是一项进行了30天中期和长期随访的事后调查，旨在评估有症状患者在PPS下进行颈内动脉支架置入术的安全性和有效性。
我们分析了120例有症状且至少存在60%狭窄患者的支架置入结果。患者年龄为67.9±9.8岁，其中12例患者年龄超过80岁。5例患者对侧动脉闭塞，26例患者双侧狭窄。本研究的主要终点是在30天随访中出现新的神经事件（包括短暂性脑缺血发作和轻度或重度中风）的患者比例。次要终点是技术和临床成功的综合指标。在长期随访中，我们评估了新的神经事件和植入支架的狭窄情况。
30天随访期间新神经事件的发生率为0.8%。由次要终点定义的技术成功率为100%。支架置入前后颈内动脉平均狭窄率分别为93.8±9%和8.4±6.3%（p<0.001）。所有病例均实现了手术成功。在长期随访中，有两例（1.7%）无症状支架内狭窄，无（0%）新的神经事件。
在PPS下对有症状的颈动脉狭窄进行血管内治疗是安全、可行的，似乎是外科内膜切除术的一个良好替代方案。
