Okuhara Shuki, Murakami Tomoaki, Toyota Shingo, Okochi Kosei, Nakashima Koichi, Tohara Kazuhiro, Yamada Shuhei, Achiha Takamune, Kobayashi Maki, Kishima Haruhiko
Department of Neurosurgery, Kansai Rosai Hospital.
Department of Neurosurgery, Osaka University Graduate School of Medicine.
Neurol Med Chir (Tokyo). 2025 Jan 15;65(1):37-44. doi: 10.2176/jns-nmc.2024-0193. Epub 2024 Nov 25.
Most previous large studies of carotid artery stenting (CAS) in maintenance hemodialysis patients are old-era, do not describe the types of stents and method of protection, and their effectiveness is unknown. CAS has progressed remarkably, and tailor-made CAS is now possible in hemodialysis patients according to the lesion. We aimed to analyze the outcomes of CAS in maintenance hemodialysis patients treated in our institution.We retrospectively investigated the data of patients who underwent elective CAS in our institution between January 2012 and April 2023. Firstly, we verified the outcomes of CAS in maintenance hemodialysis patients. Secondly, the outcomes of CAS in maintenance hemodialysis patients were compared with CAS in nondialysis patients during the same period.During the study period, 212 patients with carotid stenosis underwent CAS. Among these, 18 patients undergoing maintenance hemodialysis were identified for analysis. All 18 patients underwent lesion-specific tailor-made CAS. All 18 patients were technically successfully stented with good vasodilation and improvement in stenosis. No symptomatic cerebral infarction occurred within 30 days after CAS. There was no difference between dialysis and nondialysis patients in the risk of symptomatic complications and death occurring within 30 days after surgery. There was a higher risk of hemorrhagic complications not associated with prognosis in the dialysis group (23.1% vs 1.0%, P = 0.0047). No in-stent restenosis (>50% stenosis) and ipsilateral cerebral infarction at 1 year occurred during follow-up.CAS in hemodialysis patients may be safe and effective.
以往大多数关于维持性血液透析患者颈动脉支架置入术(CAS)的大型研究都是早期的,没有描述支架类型和保护方法,其有效性也未知。CAS已经取得了显著进展,现在可以根据病变情况为血液透析患者量身定制CAS。我们旨在分析在我们机构接受治疗的维持性血液透析患者的CAS结果。我们回顾性调查了2012年1月至2023年4月在我们机构接受择期CAS的患者数据。首先,我们验证了维持性血液透析患者的CAS结果。其次,将维持性血液透析患者的CAS结果与同期非透析患者的CAS结果进行比较。在研究期间,212例颈动脉狭窄患者接受了CAS。其中,18例接受维持性血液透析的患者被纳入分析。所有18例患者均接受了针对病变的量身定制的CAS。所有18例患者在技术上均成功置入支架,血管扩张良好,狭窄得到改善。CAS术后30天内未发生有症状的脑梗死。透析患者和非透析患者术后30天内发生有症状并发症和死亡的风险没有差异。透析组发生与预后无关的出血性并发症的风险更高(23.1%对1.0%,P = 0.0047)。随访期间1年内未发生支架内再狭窄(狭窄>50%)和同侧脑梗死。血液透析患者的CAS可能是安全有效的。