Theron J
Service de Neuroradiologie, CHRU de Caen.
J Mal Vasc. 1996;21 Suppl A:113-22.
Endovascular treatment of carotid stenoses.
259 angioplasties of carotid stenosis are reported. The stenosis was an inflammatory stenosis or a restenosis post endarterectomy in 71 cases, atherosclerotic stenosis in 188 cases. Angioplasty was performed without cerebral protection in 123 cases including a group of 38 with atherosclerotic bifurcation stenosis. A cerebral protection (triple coaxial catheter) was used in 136 atherosclerotic bifurcation stenoses.
There has been no complication related to the procedure in the 71 cases of nonatherosclerotic stenosis and the 14 cases of proximal carotid and siphon atherosclerotic stenosis. There has been 5% of dissection and 8% embolic complication in the group of 38 atherosclerotic bifurcation cases treated without cerebral protection. There has been no embolic complication in the 136 atherosclerotic bifurcation cases treated with cerebral protection. There has been 5% dissection in this group before stents and 0% after stents have been used in less then satisfactory results (61 stents placed). Restenosis has also decreased after stents (15% to 4%).
Endovascular approach can now be considered for all types of carotid stenosis. A cerebral protection with temporary carotid occlusion is mandatory in atherosclerotic carotid bifurcation cases to rule out embolic complication. Complementary stents, when necessary, have reduced the immediate risk of dissection and of restenosis later on.
颈动脉狭窄的血管内治疗。
报告了259例颈动脉狭窄血管成形术。其中71例狭窄为炎性狭窄或动脉内膜切除术后再狭窄，188例为动脉粥样硬化性狭窄。123例血管成形术未采用脑保护措施，其中包括一组38例动脉粥样硬化性分叉处狭窄。136例动脉粥样硬化性分叉处狭窄采用了脑保护装置（三同轴导管）。
71例非动脉粥样硬化性狭窄以及14例颈动脉近端和虹吸部动脉粥样硬化性狭窄患者未出现与手术相关的并发症。在未采用脑保护措施治疗的38例动脉粥样硬化性分叉处狭窄患者中，出现了5%的夹层形成和8%的栓塞并发症。在采用脑保护措施治疗的136例动脉粥样硬化性分叉处狭窄患者中未出现栓塞并发症。在该组患者中，放置支架前有5%出现夹层形成，在放置支架（共放置61枚支架）后结果欠佳的情况下夹层形成发生率为0%。支架置入后再狭窄率也有所下降（从15%降至4%）。
目前对于所有类型的颈动脉狭窄均可考虑采用血管内治疗方法。对于动脉粥样硬化性颈动脉分叉处狭窄病例，采用临时颈动脉闭塞的脑保护措施以排除栓塞并发症是必需的。必要时使用辅助支架可降低即刻夹层形成风险以及后期再狭窄风险。
