Department of Radiology, University of Health Sciences- Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey.
Department of Radiology, Sanliurfa Education and Research Hospital, Sanliurfa, Turkey.
J Clin Neurosci. 2024 Oct;128:110787. doi: 10.1016/j.jocn.2024.110787. Epub 2024 Aug 18.
To investigate the effect of embolic protection device (EPD) use on periprocedural complications in patients with carotid artery stenosis with anatomical variations.
The study retrospectively evaluated 185 patients who consecutively underwent carotid artery stenting between November 2020 and December 2023. Forty-four patients with difficult anatomical structures, anatomical variations in the common carotid artery (CCA) and internal carotid artery (ICA) (tortuosity, kinking, or coiling), and a CCA-ICA angle of >60 degrees were included in the sample. The patients were divided into two groups according to the use of EPD filters during the procedure and compared in terms of periprocedural events.
Of the 44 patients included in the study, 24 (54.5 %) were male, and the mean age of all patients was 68.7 ± 8.7 years. Comorbidities were present in 93.2 % (n = 41) of the patients. The most common comorbidity was hypertension (n = 32, 72.8 %). The CCA-ICA angle was ≥60 degrees in 45.4 % (n = 20) of all patients. ICA tortuosity was detected in 27.2 % (n = 12) of the patients, ICA kinking in 13.6 % (n = 6), ICA coiling in 6.8 % (n = 3), and CCA tortuosity in 6.8 % (n = 3). Procedure-related periprocedural events developed in 38.6 % (n = 17) of the patients. Postprocedural mortality occurred in two patients, secondary to myocardial infarction in one and COVID-19 pneumonia in the other. There was no significant difference between the filter and non-filter groups in relation to periprocedural events (p = 0.638). Major stroke did not occur in either group. Minor neurological events occurred in 15 % (n = 3/20) of the patients in the filter group and 16.7 % (n = 4/24) of those in the non-filter group. The incidence of vasospasm was statistically higher in patients using filters compared to those without filters (30 % vs. 0 %; P = 0.005, respectively).
Evaluation of vascular anatomy before carotid artery stenting is important to decide on the technical procedure to be applied in the procedure. The use of EPD in unfavorable anatomy does not reduce periprocedural neurological events. Instead, it results in technical difficulties, prolongs the duration of procedure, and leads to arterial vasospasm. Considering the high periprocedural events in this study, carotid endarterectomy may be a better alternative to endovascular treatment in patients with unfavorable carotid artery anatomy.
研究在伴有解剖变异的颈动脉狭窄患者中使用栓子保护装置（EPD）对围手术期并发症的影响。
本研究回顾性评估了 2020 年 11 月至 2023 年 12 月期间连续接受颈动脉支架置入术的 185 例患者。44 例患者存在解剖结构困难、颈总动脉（CCA）和颈内动脉（ICA）解剖变异（迂曲、扭曲或缠绕）以及 CCA-ICA 角>60 度，被纳入样本。根据术中是否使用 EPD 滤器，将患者分为两组，并比较围手术期事件。
本研究纳入的 44 例患者中，24 例（54.5%）为男性，所有患者的平均年龄为 68.7±8.7 岁。93.2%（n=41）的患者存在合并症。最常见的合并症是高血压（n=32，72.8%）。45.4%（n=20）的所有患者 CCA-ICA 角≥60 度。27.2%（n=12）的患者存在 ICA 迂曲，13.6%（n=6）存在 ICA 扭曲，6.8%（n=3）存在 ICA 缠绕，6.8%（n=3）存在 CCA 迂曲。38.6%（n=17）的患者发生了与手术相关的围手术期事件。两名患者术后死亡，其中一名死于心肌梗死，另一名死于 COVID-19 肺炎。滤器组和非滤器组在围手术期事件方面无显著差异（p=0.638）。两组均未发生大卒中。滤器组有 15%（n=3/20）的患者发生小卒中，非滤器组有 16.7%（n=4/24）的患者发生小卒中。与无滤器组相比，使用滤器的患者发生血管痉挛的发生率更高（30%比 0%；P=0.005）。
在进行颈动脉支架置入术之前评估血管解剖结构对于决定手术中应用的技术程序非常重要。在不利的解剖结构中使用 EPD 并不能降低围手术期的神经事件。相反，它会导致技术困难，延长手术时间，并导致动脉血管痉挛。考虑到本研究中围手术期事件较高，在解剖结构不良的颈动脉患者中，颈动脉内膜切除术可能是血管内治疗的更好替代方法。
