Kumar Ratheesh, Chadha Davinder, Chaddha Amitoj, Chauhan Rajeev, Singh Navreet, Kamal Pathak, Mishra Atul, Kaur Navjyot
Cardiology, Army Hospital Research and Referral, New Delhi, IND.
Cardiology, Manipal Hospital, Bengaluru, IND.
Cureus. 2022 Nov 30;14(11):e32060. doi: 10.7759/cureus.32060. eCollection 2022 Nov.
Background Carotid artery stenting (CAS) has emerged as a less invasive alternative to carotid endarterectomy (CEA) for the prevention of future cerebrovascular events in patients with carotid artery stenosis. Despite multiple randomized controlled trials (RCTs) comparing CAS and CEA for carotid disease, real-world data outside the rigorous environment of trials is scarce. Methods The present study is a prospective observational study conducted at a tertiary care center, wherein all patients who underwent CAS between January 2007 and December 2019 were included. All patients were followed up for one year of the last enrolled patient at an interval of one, six, and 12 months and then yearly thereafter. The primary composite outcome was defined as a combination of periprocedural (until 30 days of procedure) major adverse cardiac and cerebrovascular events (MACCEs) and the long-term incidence of ipsilateral stroke. The secondary outcome included the rate of restenosis. Results A total of 115 patients (86 males and 29 females) (147 lesions) who underwent CAS between 2007 and 2019 were followed up for a median of 80.5 months. Seventy-seven (67.27%) patients were symptomatic, and 38/115 (33%) were asymptomatic. Periprocedural MACCEs were noted in six patients, and four patients had ipsilateral stroke on long-term follow-up; hence, the primary composite outcome was observed in 10 (8.7%) patients. Higher age was found to be significantly associated with the primary composite outcome (p-value = 0.005). Five (4.34%) patients were lost to follow-up, while four (3.48%) patients developed restenosis. Conclusion CAS is a safe and less invasive intervention in patients with significant carotid artery stenosis and is equally effective in preventing future strokes. The incidence of primary outcome rises with an increase in age.
对于预防颈动脉狭窄患者未来发生脑血管事件，颈动脉支架置入术（CAS）已成为一种侵入性较小的替代颈动脉内膜切除术（CEA）的方法。尽管有多项比较CAS和CEA治疗颈动脉疾病的随机对照试验（RCT），但在严格试验环境之外的真实世界数据却很匮乏。方法：本研究是在一家三级医疗中心进行的前瞻性观察性研究，纳入了2007年1月至2019年12月期间所有接受CAS的患者。所有患者在最后一名入组患者随访一年期间，每隔1、6和12个月进行随访，此后每年随访一次。主要复合结局定义为围手术期（直至术后30天）主要不良心脑血管事件（MACCE）与同侧卒中的长期发生率的组合。次要结局包括再狭窄率。结果：2007年至2019年间接受CAS的115例患者（86例男性和29例女性）（147个病变）接受了中位80.5个月的随访。77例（67.27%）患者有症状，38/115例（33%）患者无症状。6例患者出现围手术期MACCE，4例患者在长期随访中发生同侧卒中；因此，10例（8.7%）患者出现主要复合结局。发现年龄较大与主要复合结局显著相关（p值=0.005）。5例（4.34%）患者失访，4例（3.48%）患者发生再狭窄。结论：CAS对有严重颈动脉狭窄的患者是一种安全且侵入性较小的干预措施，在预防未来卒中方面同样有效。主要结局的发生率随年龄增加而上升。
