Vadalà Giuseppe, Sucato Vincenzo, Costa Francesco, Castriota Fausto, Nerla Roberto, Roscitano Giuseppe, Versace Antonio Giovanni, Galassi Alfredo Ruggero, Micari Antonio
Division of Cardiology, University Hospital Paolo Giaccone, 90100 Palermo, Italy.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90146 Palermo, Italy.
J Pers Med. 2024 Feb 26;14(3):250. doi: 10.3390/jpm14030250.
To describe through emblematic images rare but clinically relevant carotid artery stenting complications that occurred at two high-volume centres for carotid artery stenting (CAS).
CAS is an alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis in patients judged to be at high risk for CEA. CAS complications range between 1 and 9% and are higher in older patients complaining of neurological symptoms at the time of presentation. Besides periprocedural or early-after-procedure stroke, which remains the true Achilles' heel of CAS, other dramatic complications might compromise the clinical outcomes of this procedure.
Five infrequent complications, out of more than 1000 CAS performed in the years 2016-2021, have been described.
Among CAS complications, acute carotid stent thrombosis, rescue retrieval of a disconnected distal cerebral embolic protection device, plaque prolapse after carotid stenting, cerebral hyperperfusion syndrome (CHS), and radial artery long sheath entrapment requiring surgical intervention were found to account for 0.3% of the total number of procedures performed by operators with high CAS volume.
Unusual CAS complications may infrequently occur, even in hands of expert operators. To know how to deal with such complications might help interventionalists to improve CAS performance.
通过典型图像描述在两个大量开展颈动脉支架置入术（CAS）的中心发生的罕见但具有临床相关性的CAS并发症。
对于被判定为颈动脉内膜切除术（CEA）高风险的患者，CAS是治疗颈动脉狭窄的一种替代方法。CAS并发症发生率在1%至9%之间，在就诊时伴有神经症状的老年患者中更高。除了围手术期或术后早期卒中（这仍然是CAS真正的致命弱点）外，其他严重并发症可能会影响该手术的临床结果。
描述了2016年至2021年期间在1000多例CAS手术中出现的5例罕见并发症。
在CAS并发症中，急性颈动脉支架血栓形成、远端脑栓塞保护装置断开后的抢救性取出、颈动脉支架置入术后斑块脱垂、脑过度灌注综合征（CHS）以及需要手术干预的桡动脉长鞘嵌顿，占高CAS手术量操作者所进行的手术总数的0.3%。
即使是在专家操作者手中，不常见的CAS并发症也可能偶尔发生。了解如何处理此类并发症可能有助于介入医生提高CAS手术的效果。
