Kapalla Marvin, Busch Albert, Wolk Steffen, Reeps Christian
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden-TU Dresden, 01307 Dresden, Germany.
J Pers Med. 2024 Feb 20;14(3):223. doi: 10.3390/jpm14030223.
The evidence regarding the treatment of open retrograde stenting of innominate artery (IA) or common carotid artery stenosis (CCA) is limited, and is suspected to carry a high risk of stroke and death. Therefore, the objective of this study was to evaluate the outcomes of such hybrid procedures.
A retrospective, monocentric study of all patients who underwent retrograde stenting of proximal IA and CCA stenosis via surgical cutdown of the CCA, with or without concomitant CEA, between 2016 and 2023 was performed.
Overall, 33 patients were treated. A total of 15 patients (45.5%) were male, with the mean age being 67 ± 9.1 years, and 58% (n = 19) of the patients presented with neurological symptoms. Open retrograde stenting was performed in 67% (n = 22) in ACC, and in 33% (n = 11) in IA stenosis. A total of 20 patients (61%) underwent retrograde stenting with synchronous ipsilateral CEA for concomitant stenosis of the carotid bifurcation. There was no 30-day mortality. The perioperative stroke rate was 3% (n = 1) with complete symptom recovery. During the follow up at 32 months (95% CI: 24-39), three late deaths (9.1%) and one symptomatic stent occlusion were observed and, in five patients (15.2%), re-intervention for restenosis was necessary.
Open retrograde stenting for of proximal IA or CCA stenosis with or without CEA, in case of tandem carotid lesions, can be performed safely with a low rate of early adverse events. Continuous follow up examinations are necessary due to relevant instent re-stenosis rates.
关于无名动脉（IA）或颈总动脉狭窄（CCA）开放逆行支架置入术治疗的证据有限，且被怀疑具有较高的中风和死亡风险。因此，本研究的目的是评估此类杂交手术的结果。
对2016年至2023年间所有通过CCA手术切开进行近端IA和CCA狭窄逆行支架置入术（无论是否同时进行CEA）的患者进行回顾性单中心研究。
总体而言，共治疗了33例患者。共有15例患者（45.5%）为男性，平均年龄为67±9.1岁，58%（n = 19）的患者出现神经症状。67%（n = 22）的患者在ACC中进行了开放逆行支架置入术，33%（n = 11）的患者在IA狭窄中进行了该手术。共有20例患者（61%）因颈动脉分叉处同时狭窄而在逆行支架置入术的同时进行了同侧CEA。无30天死亡率。围手术期卒中发生率为3%（n = 1），症状完全恢复。在32个月的随访期间（95%CI：24 - 39），观察到3例晚期死亡（9.1%）和1例有症状的支架闭塞，5例患者（15.2%）因再狭窄需要再次干预。
对于串联颈动脉病变，无论是否进行CEA，近端IA或CCA狭窄的开放逆行支架置入术均可安全进行，早期不良事件发生率较低。由于相关的支架内再狭窄率，持续的随访检查是必要的。
