Department of Vascular and Endovascular Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt.
Vascular and endovascular surgery unit university of Perugia, ospedale S.Maria della Misericordia, Perugia, Italy.
Vascular. 2024 Aug;32(4):774-783. doi: 10.1177/17085381231160957. Epub 2023 Mar 3.
Carotid artery stenting (CAS) is considered an important tool in carotid revascularization. Carotid artery stenting is usually performed by using self-expandable stent with different designs. The stent design influences many physical characteristics. Also, it may affect the complication rate with special relevance to perioperative stroke, hemodynamic instability, and late restenosis.
This study comprised all consecutive patients who underwent carotid artery stenting for atherosclerotic carotid stenosis from March 2014 to May 2021. Both symptomatic patient and asymptomatic patients were included. Patients with a symptomatic carotid stenosis of ≥50% or asymptomatic carotid stenosis of ≥60% were selected for carotid artery stenting . Patients with fibromuscular dysplasia and acute or unstable plaque were not included. Variables of clinical relevance were tested in multivariable analysis using binary logistic regression model.
A total of 728 patients were enrolled. The majority of this cohort was asymptomatic (578/728, 79.4%), while 150/728 (20.6%) were symptomatic. The mean degree of carotid stenosis was 77.82 ± 4.73%, with a mean plaque length of 1.76 ± 0.55 cm. A total of 277 (38%) patients were treated with Xact® Carotid Stent System. Successful carotid artery stenting was achieved in 698 (96%) of patients. Of these patients, stroke rate in symptomatic patients was nine (5.8%), while in asymptomatic patients was 20 (3.4%). In a multivariable analysis, the open-cell carotid stent was not associated with a differential risk for combined acute and sub-acute neurologic complications as compared with closed-cell stents. Patients treated with open cell stents had a significantly lower rate of procedural hypotension ( 0.0188) at bivariate analysis.
Carotid artery stenting is considered a safe alternative to CEA that can be used in selected average surgical risk patient. Different stent designs can affect the rate of major adverse events in carotid artery stenting patients, but further studies are necessary with avoiding different bias to study the effect of different stent designs.
颈动脉支架置入术（CAS）被认为是颈动脉血运重建的重要工具。颈动脉支架置入术通常使用具有不同设计的自膨式支架进行。支架设计会影响许多物理特性。此外，它可能会影响围手术期卒中、血流动力学不稳定和晚期再狭窄等并发症的发生率。
本研究纳入了 2014 年 3 月至 2021 年 5 月期间因动脉粥样硬化性颈动脉狭窄而行颈动脉支架置入术的所有连续患者。包括有症状和无症状的患者。选择有症状颈动脉狭窄≥50%或无症状颈动脉狭窄≥60%的患者进行颈动脉支架置入术。不包括纤维肌性发育不良和急性或不稳定斑块的患者。使用二元逻辑回归模型对多变量分析中的临床相关变量进行测试。
共纳入 728 例患者。该队列的大多数为无症状（578/728，79.4%），而有症状（150/728，20.6%）的患者较少。颈动脉狭窄的平均程度为 77.82±4.73%，平均斑块长度为 1.76±0.55cm。共有 277 例（38%）患者接受了 Xact®颈动脉支架系统治疗。698 例（96%）患者成功进行了颈动脉支架置入术。在这些患者中，症状性患者的卒中发生率为 9 例（5.8%），而无症状患者为 20 例（3.4%）。在多变量分析中，与密网支架相比，开网支架并不与联合急性和亚急性神经并发症的风险差异相关。在双变量分析中，接受开孔支架治疗的患者发生程序低血压的发生率显著较低（0.0188）。
颈动脉支架置入术被认为是一种安全的替代 CEA 的方法，可用于选择平均手术风险的患者。不同的支架设计可能会影响颈动脉支架置入术患者的主要不良事件发生率，但需要进一步的研究，以避免不同的偏倚来研究不同支架设计的效果。
