无症状颈动脉狭窄患者颈动脉支架置入术后脑梗死的临床特征和影像学模式:八年历程

IF 0.8 Q4 CLINICAL NEUROLOGY
A. Pai, Padmakumar Ramachandran, Ashish Rai, Sripadma Pv
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引用次数: 0

摘要

近来,针对无症状颈动脉狭窄(SCS)的颈动脉支架植入术(CAS)已成为一种极具吸引力的选择。CAS和症状性颈动脉狭窄脑卒中的地形模式尚未得到充分研究。为此,我们开展了一项研究,分析颈动脉支架置入术的梗死模式和并发症,并确定支架置入术后的结果预测因素。这项研究是一项单中心回顾性研究,时间从 2015 年 1 月 1 日至 2022 年 12 月 31 日,研究对象是接受颈动脉支架置入术并随访至少 6 个月的 SCS 患者。研究记录了梗死模式、血管造影结果、手术并发症和预后(良好[改良Rankin量表(mRS)≤2]或不良[mRS>2])。对定性和定量变量进行了卡方和方差分析。单变量分析中的重要变量被纳入回归分析,并确定了结果预测因素。46例(47.91%)、12例(12.50%)和38例(39.58%)患者患有区域性梗死(TI)、边界区梗死(BZI)和混合性梗死(MI)。美国国立卫生研究院卒中量表(NIHSS)小于 5 和短暂性脑缺血发作(TIA)显著(P < 0.05),而 TI 与 BZI 与 MI 的威利斯圈异常程度相当。支架植入过程中出现心动过缓(54.16%)和血管痉挛(19.79%)。97.87%的患者成功实现了血管再通(残余狭窄<20%)。TI 与 BZI 与 MI 的手术并发症相当。轻微的脑过度灌注综合征(CHS)表现为头痛(9.57%)、癫痫发作(2.12%),高峰期在 6 到 12 小时之间,严重的表现为基底节出血和死亡。没有大面积中风。64.13%和75.28%的患者在1个月和6个月后的mRS分别达到良好水平。NIHSS≤10、早期干预(≤2周)、无糖尿病、高血压或缺血性心脏病对良好预后有显著影响(P<0.05)。NIHSS≤10、1个月时无高血压和NIHSS≤10、6个月时无糖尿病是良好预后的预测因素。总体而言,CAS是一种安全有效的手术,74.15%的患者在6个月后获得了良好的治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical characteristics and imaging patterns of cerebral infarction with outcomes of carotid artery stenting in symptomatic carotid stenosis: An eight-year journey
Carotid artery stenting (CAS) for symptomatic carotid stenosis (SCS) has emerged as an attractive option in recent times. CAS and topographical patterns of stroke in symptomatic stenosis have been inadequately addressed. With this objective, we conducted a study to analyze infarct patterns and complications of carotid stenting and determine outcome predictors after stenting. A single-center retrospective study from January 01, 2015, to December 31, 2022, on patients with SCS, who underwent carotid stenting with at least six months of follow-up was conducted. Infarct patterns, angiographic findings, procedural complications, and outcomes (favorable [modified Rankin scale (mRS) ≤2] or unfavorable [mRS >2]) were recorded. Chi-square, analysis of variance for qualitative and quantitative variables was employed. Significant variables on univariate analysis were entered into regression and outcome predictors were determined. Ninety-six records were included in the study. Forty-six (47.91%), 12 (12.50%), and 38 (39.58%) patients had territorial infarcts (TIs), border-zone infarcts (BZIs), and mixed infarcts (MIs). National Institutes of Health Stroke Scale (NIHSS) <5 and transient ischemic attack (TIA) were significant (P < 0.05) while the circle of Willis anomalies were comparable in TI versus BZI versus MI. Bradycardia (54.16%) and vessel spasm (19.79%) were noted during stenting. Successful revascularization (residual stenosis <20%) was achieved in 97.87%. Procedural complications were comparable in TI versus BZI versus MI. Minor cerebral hyperperfusion syndrome (CHS) with headache (9.57%), seizure (2.12%) peaking between 6 and 12 h, and severe with basal ganglia hemorrhage and death occurred. There were no major strokes. 64.13% and 75.28% achieved a favorable mRS at one and six months, respectively. NIHSS ≤10, early intervention (≤ 2 weeks), absence of diabetes, hypertension, or ischemic heart disease were significant (P < 0.05) for a favorable outcome. NIHSS ≤10, absence of hypertension at one month and NIHSS ≤10, absence of diabetes at six months were predictors of a favorable outcome. Severe carotid disease predisposed to CHS. Overall, CAS was a safe and effective procedure with 74.15% achieving favorable outcomes at six months.
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CiteScore
2.10
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129
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