Calo Paolo, Oberhuber Alexander, Görtz Hartmut
Department of Vascular Surgery, Bonifatius Hospital Lingen, 49808 Lingen, Germany.
Department of Vascular and Endovascular Surgery, University Hospital Muenster, 48149 Muenster, Germany.
J Clin Med. 2023 May 18;12(10):3534. doi: 10.3390/jcm12103534.
The gold standard for the treatment of carotid artery stenosis is the carotid endarterectomy (CEA). According to current guidelines, carotid artery stenting (CAS) is an alternative. Randomized control trials (RCTs) show significantly higher rates of peri-interventional strokes after CAS compared to CEA. However, these trials were usually characterized by a great heterogeneity in the CAS procedure. In this retrospective analysis from 2012 to 2020, 202 symptomatic and asymptomatic patients were treated with CAS. Patients were carefully pre-selected according to anatomical and clinical criteria. In all cases, the same steps and material were used. All interventions were performed by five experienced vascular surgeons. Primary endpoints of this study were perioperative death and stroke. Asymptomatic carotid stenosis was present in 77% of the patients and symptomatic in 23%. The mean age was 66 years. The average degree of stenosis was 81%. The CAS technical success rate was 100%. Periprocedural complications occurred in 1.5% of cases, including one major stroke (0.5%) and two minor strokes (1%). The results of this study indicate that through a strict patient selection based on anatomical and clinical criteria, CAS can be performed with very low complication rates. Furthermore, standardization of the materials and the procedure itself is crucial.
颈动脉内膜切除术（CEA）是治疗颈动脉狭窄的金标准。根据现行指南，颈动脉支架置入术（CAS）是一种替代方法。随机对照试验（RCT）表明，与CEA相比，CAS术后围手术期卒中发生率显著更高。然而，这些试验的特点通常是CAS手术存在很大的异质性。在这项2012年至2020年的回顾性分析中，202例有症状和无症状患者接受了CAS治疗。根据解剖和临床标准对患者进行了仔细的预先筛选。在所有病例中，使用相同的步骤和材料。所有干预均由五位经验丰富的血管外科医生进行。本研究的主要终点是围手术期死亡和卒中。77%的患者存在无症状性颈动脉狭窄，23%有症状。平均年龄为66岁。平均狭窄程度为81%。CAS技术成功率为100%。围手术期并发症发生率为1.5%，包括1例严重卒中（0.5%）和2例轻度卒中（1%）。本研究结果表明，通过基于解剖和临床标准的严格患者选择，CAS可以以非常低的并发症发生率进行。此外，材料和手术本身的标准化至关重要。
