Kang Beom Mo, Yoon Seok Mann, Oh Jae Sang, Oh Hyuk Jin, Ahn Jae Min, Yun Gi Yong
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2023 Jun;25(2):160-174. doi: 10.7461/jcen.2023.E2022.07.007. Epub 2023 Jan 31.
Carotid artery stenting (CAS) is currently widely used for the treatment of carotid artery stenosis. The objective of this study was to analyze the outcomes of CAS performed in a single institution.
We retrospectively analyzed 313 CAS cases from January 2007 to December 2020, including 206 (66%) symptomatic and 107 (34%) asymptomatic cases. Procedure-related morbidity and mortality were assessed. Rates of periprocedural (≤30 days after CAS) and postprocedural ipsilateral strokes (>30 days after CAS) were also assessed. Logistic regression analysis was used to identify risk factors for the periprocedural complication, in-stent restenosis (ISR), and ipsilateral stroke.
The success rate of CAS was 98%. Among 313 cases, 1 patient died due to hyperperfusion-related intracerebral hemorrhage (ICH). The CAS-related mortality rate was 0.31%. The overall incidence of periprocedural complications is 5.1%. A risk factor for periprocedural complication was a symptomatic carotid artery stenosis (7.3% vs. 0.9%, p=0.016). Twenty cases of ISR occurred during 63.7±42.1 months of follow-up. The overall incidence of ISR was 10.2% (20/196). A risk factors for ISR were diabetes mellitus (17.6% vs. 5.7%, p=0.008) and patients who used Open-cell stents (19.6% vs. 6.9%, p=0.010). The overall incidence of ipsilateral stroke is 5.6%. A risk factors for ipsilateral stroke was ISR (95% CI, p=0.002).
CAS is a safe and effective procedure for carotid artery stenosis. Although the incidence of complications is low, fatal complication such as hyperperfusion- related ICH can occur. To prevent hyperperfusion-related ICH, several methods such as strict blood pressure (BP) control, intentional less widening of stenotic segment should be used. To prevent ISR or stroke occurrence, special attention should be paid to patients who have ISR or ipsilateral stroke risk factors.
颈动脉支架置入术（CAS）目前广泛应用于治疗颈动脉狭窄。本研究的目的是分析在单一机构进行的CAS的治疗结果。
我们回顾性分析了2007年1月至2020年12月期间的313例CAS病例，其中包括206例（66%）有症状病例和107例（34%）无症状病例。评估了与手术相关的发病率和死亡率。还评估了围手术期（CAS后≤30天）和术后同侧卒中（CAS后>30天）的发生率。采用逻辑回归分析确定围手术期并发症、支架内再狭窄（ISR）和同侧卒中的危险因素。
CAS的成功率为98%。在313例病例中，1例患者因与高灌注相关的脑出血（ICH）死亡。CAS相关死亡率为0.31%。围手术期并发症的总发生率为5.1%。围手术期并发症的一个危险因素是有症状的颈动脉狭窄（7.3%对0.9%，p=0.016）。在63.7±42.1个月的随访期间发生了20例ISR。ISR的总发生率为10.2%（20/196）。ISR的危险因素是糖尿病（17.6%对5.7%，p=0.008）和使用开放式支架的患者（19.6%对6.9%，p=0.010）。同侧卒中的总发生率为5.6%。同侧卒中的一个危险因素是ISR（95%CI，p=0.002）。
CAS是治疗颈动脉狭窄的一种安全有效的手术。虽然并发症的发生率较低，但可能会发生如与高灌注相关的ICH等致命并发症。为预防与高灌注相关的ICH，应采用严格控制血压（BP）、有意减少狭窄段扩张等多种方法。为预防ISR或卒中的发生，应特别关注有ISR或同侧卒中危险因素的患者。
