Kizilkilic Esra Kochan, Akan Yeşim Namdar, Atbas Baran, Karagöz Seyfullah Halit, Korkmazer Bora, Arslan Serdar, Islak Civan, Kocer Naci, Kizilkilic Osman
Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Türkiye.
Department of Neuroradiology, Cerrahpaşa Faculty of Medicine, Istanbul University-, Cerrahpaşa, Istanbul, Türkiye.
Neuroradiology. 2025 Feb;67(2):393-401. doi: 10.1007/s00234-024-03524-7. Epub 2024 Dec 21.
Patients with contralateral carotid artery occlusion (CCO) represent a subgroup of patients at risk for revascularization procedures. The choice of appropriate revascularization procedure (carotid endarterectomy (CEA) or carotid artery stenting (CAS)) in these patients is controversial. The aim of this study is to share the results of clinical and radiological follow-up after CAS in these patients and to contribute to the literature by evaluating the efficacy and safety of stenting.
In our study, the clinical and radiological data of 145 patients with CCO and 145 age-gender-matched patients without CCO who underwent elective CAS in the interventional neuroradiology clinic between 2001 and 2023 were retrospectively analyzed. A comparison was made between short- and long-term outcomes between the two groups.
The overall technical success rate of CAS was 99.7% and the 30-day all-cause mortality rate was 1.4%. There was no statistically significant difference between the two groups in terms of early-term (intra-procedural thromboembolic events, post-procedural symptomatic hyperperfusion, intraparenchymal hemorrhage, major and minor ischemic stroke, early-term mortality rate) and long-term (intimal hyperplasia, residual stenosis, major and minor ischemic stroke and long-term all-cause mortality rate) (p > 0.05).
In our experience, it was concluded that CAS performed by an experienced interventional neuroradiology team in patients with CCO does not pose an additional risk. Since CCO poses a risk for CAE, CAS may be a more acceptable treatment modality in these patients due to less perioperative risk. However, further research is required to support our findings.
对侧颈动脉闭塞（CCO）患者是血管重建手术的高危亚组。在这些患者中选择合适的血管重建手术（颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS））存在争议。本研究的目的是分享这些患者接受CAS后的临床和影像学随访结果，并通过评估支架置入术的疗效和安全性为文献做出贡献。
在我们的研究中，回顾性分析了2001年至2023年间在介入神经放射科门诊接受择期CAS的145例CCO患者和145例年龄、性别匹配的非CCO患者的临床和影像学数据。对两组的短期和长期结果进行了比较。
CAS的总体技术成功率为99.7%，30天全因死亡率为1.4%。两组在早期（术中血栓栓塞事件、术后症状性高灌注、脑实质内出血、轻重度缺血性卒中、早期死亡率）和长期（内膜增生、残余狭窄、轻重度缺血性卒中和长期全因死亡率）方面均无统计学显著差异（p>0.05）。
根据我们的经验，得出的结论是，由经验丰富的介入神经放射科团队对CCO患者进行CAS不会带来额外风险。由于CCO对CEA构成风险，CAS可能因围手术期风险较小而成为这些患者更可接受的治疗方式。然而，需要进一步的研究来支持我们的发现。
