Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
Neurovascular Research and Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan.
JACC Cardiovasc Interv. 2024 May 13;17(9):1148-1159. doi: 10.1016/j.jcin.2024.03.014.
The effectiveness and safety of carotid artery stenting (CAS) are comparable to those of carotid endarterectomy in both symptomatic and asymptomatic patients with carotid artery stenosis, but real-world outcomes are not well-known.
The purpose of this study was to investigate the real-world clinical outcomes of CAS in symptomatic and asymptomatic patients with carotid artery stenosis.
We conducted a nationwide retrospective registry study of 156 centers between January 2015 and December 2019. We enrolled consecutive patients with CAS managed by certified specialists from the Japanese Society of Neuroendovascular Therapy. Outcomes between symptomatic and asymptomatic patients were compared. The primary outcome was a composite of ischemic stroke and all-cause death at 30 days after CAS. Secondary outcomes were ischemic stroke, all-cause death, intracranial hemorrhage (ICH), and procedural complications.
We analyzed 9,792 patients (symptomatic, n = 5,351; asymptomatic, n = 4,441). The mean age was 73.5 years, and men were dominant (86.4%). Embolism protection devices were used in 99% of patients. The primary outcome was not significantly different between the symptomatic and asymptomatic groups (120 [2.2%] vs 65 [1.5%]; adjusted OR: 1.30; 95% CI: 0.92-1.83). The incidences of symptomatic ICH, any ICH, acute in-stent occlusion, and hyperperfusion syndrome were significantly more prevalent in the symptomatic group (47 [0.9%] vs 8 [0.2%], aOR: 4.41 [95% CI: 1.68-11.6]; 73 [1.4%] vs 12 [0.3%], aOR: 3.56 [95% CI: 1.71-7.39]; 45 [0.8%] vs 19 [0.4%], aOR: 2.18 [95% CI: 1.08-4.40]; and 102 [1.9%] vs 36 [0.8%], aOR: 1.78 [95% CI: 1.17-2.71], respectively). Other secondary outcomes were not significantly different between the 2 groups.
The complication rate after specialist-involved CAS at 30 days was low in real-world practice.
颈动脉支架置入术（CAS）在有症状和无症状颈动脉狭窄患者中的有效性和安全性与颈动脉内膜切除术相当，但真实世界的结果尚不清楚。
本研究旨在探讨症状性和无症状性颈动脉狭窄患者 CAS 的真实世界临床结局。
我们进行了一项全国性的回顾性登记研究，纳入了 2015 年 1 月至 2019 年 12 月期间 156 个中心的连续患者，这些患者接受了日本神经血管治疗学会认证专家管理的 CAS。比较了有症状和无症状患者的结局。主要结局为 CAS 后 30 天内缺血性卒中和全因死亡的复合结局。次要结局为缺血性卒中和全因死亡、颅内出血（ICH）和手术并发症。
共分析了 9792 例患者（有症状组 5351 例，无症状组 4441 例）。平均年龄为 73.5 岁，男性占主导地位（86.4%）。99%的患者使用了栓塞保护装置。主要结局在症状组和无症状组之间无显著差异（120 例[2.2%] vs 65 例[1.5%]；调整后的 OR：1.30；95%CI：0.92-1.83）。症状性 ICH、任何 ICH、急性支架内闭塞和高灌注综合征的发生率在症状组中明显更高（47 例[0.9%] vs 8 例[0.2%]，aOR：4.41；95%CI：1.68-11.6；73 例[1.4%] vs 12 例[0.3%]，aOR：3.56；95%CI：1.71-7.39；45 例[0.8%] vs 19 例[0.4%]，aOR：2.18；95%CI：1.08-4.40；102 例[1.9%] vs 36 例[0.8%]，aOR：1.78；95%CI：1.17-2.71）。两组其他次要结局无显著差异。
真实世界实践中，专家参与的 CAS 术后 30 天的并发症发生率较低。
