Department of Surgery, University of Rochester, Rochester, NY.
Department of Surgery, University of Rochester, Rochester, NY.
J Vasc Surg. 2023 Jul;78(1):150-157. doi: 10.1016/j.jvs.2023.03.017. Epub 2023 Mar 12.
We sought to quantify the percent calcification within carotid artery plaques and assess its impact on percent residual stenosis and rate of restenosis in patients undergoing transcarotid artery revascularization for symptomatic and asymptomatic carotid artery stenosis.
A retrospective review of prospectively collected institutional Vascular Quality Initiative data was performed to identify all patients undergoing transcarotid artery revascularization from December 2015 to June 2021 (n = 210). Patient and lesion characteristics were extracted. Using a semiautomated workflow, preoperative computed tomography head and neck angiograms were analyzed to determine the calcified plaque volume in distal common carotid artery and internal carotid artery plaques. Intraoperative digital subtraction angiograms were reviewed to calculate the percent residual stenosis post-intervention according to North American Symptomatic Carotid Endarterectomy Trial criteria. Peak systolic velocity and end-diastolic velocity were extracted from outpatient carotid duplex ultrasound examinations. Univariate logistic regression was performed to analyze the relationship of calcium volume percent and Vascular Quality Initiative lesion calcification to percent residual stenosis in completion angiograms. Kaplan-Meier analysis examined the relationship between calcium volume percent and in-stent stenosis over 36 months.
One hundred ninety-seven carotid arteries were preliminarily examined. Predilation was performed in 87.4% of cases with a mean balloon diameter of 5.1 ± 0.7 mm and a mean stent diameter was 8.8 ± 1.1 mm. The mean calcium volume percent was 11.9 ± 12.4% and the mean percent residual stenosis was 16.1 ± 15.6%. Univariate logistic regression demonstrated a statistically significant difference between calcium volume percent and percent residual stenosis (odds ratio [OR], 1.324; 95% confidence interval [CI], 1.005-1.746; P = .046). Stratified by quartile, only the top 25% of calcified plaques (>18.7% calcification) demonstrated a statistically significant association with higher percent residual stenosis (OR, 2.532; 95% CI, 1.049-6.115; P =.039). There was no statistical significance with lesion calcification (OR, 1.298; 95% C,: 0.980-1.718; P = .069). A Kaplan-Meier analysis demonstrated a statistically significant increase in the rate of in-stent stenosis during a 36-month follow-up for lesions containing >8.2% calcium volume (P = .0069).
A calcium volume percent of >18.7% was associated with a higher percent residual stenosis, and a calcium volume percent of >8.2% was associated with higher in-stent stenosis at 36 months. There was one clinically diagnosed stroke during the follow-up period, demonstrating the overall safety of the procedure.
我们旨在量化颈动脉斑块内的钙化百分比，并评估其对接受颈动脉血运重建术治疗有症状和无症状颈动脉狭窄患者的残余狭窄百分比和再狭窄率的影响。
对前瞻性收集的机构血管质量倡议数据进行回顾性分析，以确定 2015 年 12 月至 2021 年 6 月期间接受颈动脉血运重建术的所有患者（n=210）。提取患者和病变特征。使用半自动工作流程，分析术前计算机断层颈部血管造影以确定远端颈总动脉和颈内动脉斑块中的钙化斑块体积。回顾术中数字减影血管造影以根据北美症状性颈动脉内膜切除术试验标准计算术后残余狭窄百分比。从门诊颈动脉双功能超声检查中提取收缩期峰值速度和舒张末期速度。采用单因素 logistic 回归分析钙体积百分比和血管质量倡议病变钙化与血管造影术完成时残余狭窄百分比的关系。Kaplan-Meier 分析检查了 36 个月内钙体积百分比与支架内狭窄之间的关系。
初步检查了 197 条颈动脉。87.4%的病例进行了预扩张，球囊直径平均为 5.1±0.7mm，支架直径平均为 8.8±1.1mm。钙体积百分比平均为 11.9±12.4%，残余狭窄百分比平均为 16.1±15.6%。单因素 logistic 回归显示钙体积百分比与残余狭窄百分比之间存在统计学差异（比值比[OR]，1.324；95%置信区间[CI]，1.005-1.746；P=0.046）。按四分位距分层，只有最高的 25%的钙化斑块（>18.7%的钙化）与较高的残余狭窄百分比有统计学显著关联（OR，2.532；95%CI，1.049-6.115；P=0.039）。病变钙化无统计学意义（OR，1.298；95%CI，0.980-1.718；P=0.069）。Kaplan-Meier 分析显示，在 36 个月的随访期间，含有>8.2%钙体积的病变中支架内狭窄的发生率有统计学显著增加（P=0.0069）。
钙体积百分比>18.7%与残余狭窄百分比较高相关，钙体积百分比>8.2%与 36 个月时支架内狭窄较高相关。在随访期间发生了一例临床诊断的中风，证明了该手术的总体安全性。
