Beom Mo Kang, Seok Mann Yoon, Jae Sang Oh, Hyuk Jin Oh, Jae Min Ahn, Gi Yong Yun
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引用次数: 1
Abstract
Objective: Carotid artery stenting (CAS) is currently widely used for the treatment of carotid artery stenosis. The objective of this study was to analyze the outcomes of CAS performed in a single institution.
Methods: We retrospectively analyzed 313 CAS cases from January 2007 to December 2020, including 206 (66%) symptomatic and 107 (34%) asymptomatic cases. Procedure-related morbidity and mortality were assessed. Rates of periprocedural (≤30 days after CAS) and postprocedural ipsilateral strokes (>30 days after CAS) were also assessed. Logistic regression analysis was used to identify risk factors for the periprocedural complication, in-stent restenosis (ISR), and ipsilateral stroke.
Results: The success rate of CAS was 98%. Among 313 cases, 1 patient died due to hyperperfusion-related intracerebral hemorrhage (ICH). The CAS-related mortality rate was 0.31%. The overall incidence of periprocedural complications is 5.1%. A risk factor for periprocedural complication was a symptomatic carotid artery stenosis (7.3% vs. 0.9%, p=0.016). Twenty cases of ISR occurred during 63.7±42.1 months of follow-up. The overall incidence of ISR was 10.2% (20/196). A risk factors for ISR were diabetes mellitus (17.6% vs. 5.7%, p=0.008) and patients who used Open-cell stents (19.6% vs. 6.9%, p=0.010). The overall incidence of ipsilateral stroke is 5.6%. A risk factors for ipsilateral stroke was ISR (95% CI, p=0.002).
Conclusions: CAS is a safe and effective procedure for carotid artery stenosis. Although the incidence of complications is low, fatal complication such as hyperperfusion- related ICH can occur. To prevent hyperperfusion-related ICH, several methods such as strict blood pressure (BP) control, intentional less widening of stenotic segment should be used. To prevent ISR or stroke occurrence, special attention should be paid to patients who have ISR or ipsilateral stroke risk factors.
目的:颈动脉支架植入术(CAS)是目前广泛应用于治疗颈动脉狭窄的一种方法。本研究的目的是分析在单一机构进行CAS的结果。方法:回顾性分析2007年1月至2020年12月313例CAS病例，其中有症状206例(66%)，无症状107例(34%)。评估手术相关的发病率和死亡率。同时评估术中(术后≤30天)和术后同侧卒中(术后>30天)的发生率。采用Logistic回归分析确定围手术期并发症、支架内再狭窄(ISR)和同侧卒中的危险因素。结果:手术成功率98%。313例患者中，1例死于高灌注相关性脑出血(ICH)。cass相关死亡率为0.31%。围手术期并发症的总发生率为5.1%。围手术期并发症的危险因素是有症状的颈动脉狭窄(7.3% vs 0.9%， p=0.016)。随访63.7±42.1个月，共发生20例ISR。ISR的总发生率为10.2%(20/196)。糖尿病(17.6% vs. 5.7%， p=0.008)和使用开放细胞支架的患者(19.6% vs. 6.9%， p=0.010)是发生ISR的危险因素。同侧脑卒中的总发生率为5.6%。同侧卒中的危险因素是ISR (95% CI, p=0.002)。结论:颈动脉动脉栓塞术是一种安全有效的治疗颈动脉狭窄的方法。虽然并发症的发生率较低，但可发生致命性并发症，如高灌注相关性脑出血。为预防高灌注相关性脑出血，应采用严格控制血压、有意减少狭窄段加宽等方法。为了预防ISR或卒中的发生，应特别注意有ISR或同侧卒中危险因素的患者。
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