Tsai Cheng-Hsuan, Chen Ying-Hsien, Chen Chun-Kai, Liu Sheng-Fu, Ko Tsung-Yu, Meng Shih-Wei, Yeh Chih-Fan, Huang Ching-Chang, Hung Chi-Sheng, Lin Mao-Shin, Kao Hsien-Li
National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
Eur J Radiol. 2025 Oct;191:112297. doi: 10.1016/j.ejrad.2025.112297. Epub 2025 Jul 8.
Carotid artery near-occlusion (CANO) is an underdiagnosed condition, and the benefit of revascularizing CANO unproven. This study investigates the long-term outcomes of carotid artery stenting (CAS) in patients with CANO.
We conducted a retrospective study of patients who underwent CAS for carotid stenosis, including CANO and non-CANO groups. CANO was defined as post-stenotic narrowing of the distal internal carotid artery (ICA). The CANO group was further classified based on the presence or absence of full collapse defined as a distal ICA lumen diameter ≤ 2 mm and/or an ipsilateral-to-contralateral ICA ratio ≤ 0.42. The outcome measures included peri-procedural and long-term events, including stroke, mortality, and major adverse cerebrovascular events (MACE).
123 patients with CANO and 173 patients with non-CANO carotid stenosis were retrospectively enrolled. Age and sex were comparable between groups. The CANO group had a higher proportion of patients with symptomatic lesions (36.6%) compared to the non-CANO group (25.4%), with the highest rate observed in CANO patients with full collapse (51.9%). Peri-procedural outcomes were similar between groups. There were no significant differences in long-term outcomes between the CANO and non-CANO groups, nor between CANO patients with or without full collapse. Bilateral significant ICA stenosis was a significant predictor of long-term MACE, whereas the presence of CANO or full collapse was not.
CAS is a viable option for patients with CANO, providing comparable long-term outcomes to those with conventional carotid stenosis. The presence of CANO with or without full collapse is not associated with worse outcomes.
颈动脉近闭塞（CANO）是一种诊断不足的疾病，对CANO进行血运重建的益处尚未得到证实。本研究调查了CANO患者接受颈动脉支架置入术（CAS）的长期预后。
我们对因颈动脉狭窄接受CAS的患者进行了一项回顾性研究，包括CANO组和非CANO组。CANO定义为颈内动脉（ICA）远端的狭窄后狭窄。CANO组根据是否存在完全闭塞进一步分类，完全闭塞定义为ICA远端管腔直径≤2mm和/或同侧与对侧ICA比值≤0.42。结局指标包括围手术期和长期事件，包括卒中、死亡率和主要不良脑血管事件（MACE）。
回顾性纳入123例CANO患者和173例非CANO颈动脉狭窄患者。两组患者的年龄和性别具有可比性。与非CANO组（25.4%）相比，CANO组有症状性病变的患者比例更高（36.6%），在完全闭塞的CANO患者中观察到的比例最高（51.9%）。两组围手术期结局相似。CANO组和非CANO组之间以及有或无完全闭塞的CANO患者之间的长期结局均无显著差异。双侧严重ICA狭窄是长期MACE的重要预测因素，而CANO或完全闭塞的存在则不是。
CAS是CANO患者的一种可行选择，其长期预后与传统颈动脉狭窄患者相当。无论是否存在完全闭塞，CANO的存在均与较差的预后无关。
