Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Sci Rep. 2022 Mar 18;12(1):4687. doi: 10.1038/s41598-022-08807-8.
Previously we described the protocol-based decision for choosing the proper surgical treatment option for carotid stenosis. The objective of this study is to describe our experiences of using this scoring protocol in the selection of endarterectomy or stenting for carotid stenosis. Between October 2014 and March 2018, the scoring protocol was applied to a total of 105 consecutive patients. Eighty (76.2%) patients had symptomatic stenosis ≥ 50%, and 25 (23.8%) patients had asymptomatic stenosis ≥ 80%. We also speculated about how effectively the protocol worked in the real clinical setting. Stenting was performed in 73 patients and endarterectomy in 32 patients. Overall, 98 (93.3%) patients were treated according to the protocol, while the protocol was violated in seven (6.7%) patients. Sixty-one (58.1%) patients received treatments that were decided by the protocol. There were 37 (35.2%) patients who had the same score for both treatment options. Among these patients, 28 patients underwent stenting and nine patients underwent endarterectomy. In the stenting cases, 90.4% of the patients followed the protocol and violations occurred in 9.6%. In the endarterectomy cases, all of the patients followed the protocol. Overall, one patient had a procedure-related complication without morbidity. During the 12-month follow-ups, there were no restenoses or major strokes. Minor strokes were diagnosed in three (2.8%) patients. In patients with carotid artery stenosis, stenting and endarterectomy should be considered simultaneously together, not against each other. Our scoring protocol can be used to weigh these options and applied in clinical practice.
先前，我们描述了基于方案的决策，以选择颈动脉狭窄的适当手术治疗方案。本研究的目的是描述我们使用该评分方案选择颈动脉狭窄内膜切除术或支架置入术的经验。2014 年 10 月至 2018 年 3 月期间，该评分方案共应用于 105 例连续患者。80 例（76.2%）患者为症状性狭窄≥50%，25 例（23.8%）患者为无症状性狭窄≥80%。我们还推测该方案在实际临床环境中的有效性。73 例患者接受支架置入术，32 例患者接受内膜切除术。总体而言，98 例（93.3%）患者按方案治疗，7 例（6.7%）患者违反方案。61 例（58.1%）患者接受了方案决定的治疗。有 37 例（35.2%）患者两种治疗方案的评分相同。在这些患者中，28 例患者接受支架置入术，9 例患者接受内膜切除术。在支架置入病例中，90.4%的患者遵循方案，违反方案的占 9.6%。在内膜切除术病例中，所有患者均遵循方案。总体而言，1 例患者发生与手术相关的并发症，无发病率。在 12 个月的随访中，无再狭窄或主要卒中。3 例（2.8%）患者诊断为轻度卒中。在颈动脉狭窄患者中，应同时考虑支架置入术和内膜切除术，而不是相互排斥。我们的评分方案可用于权衡这些选择，并应用于临床实践。
