颈动脉支架置入术与颈动脉内膜切除术对颈外动脉通畅的不同影响。

E. Woo, J. Karmacharya, O. Velazquez, J. Carpenter, C. Skelly, R. Fairman
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引用次数: 7

摘要

目的探讨颈动脉支架植入术(CAS)后支架覆盖颈外动脉(ECA)与颈动脉内膜切除术(CEA)后外翻颈外动脉内膜切除术(ECA)的效果。方法回顾近2年来101例CAS和165例CEA手术记录。术前、术后1个月和6个月分别进行双速、病史和体格检查。通过将支架穿过颈内动脉(ICA)病变延伸至颈总动脉(CCA)从而覆盖颈总动脉(ECA)进行CAS。CEA与ECA外翻动脉内膜切除术同时进行。结果ICA术前和cea术前的平均峰值收缩速度(PSV)分别为361和352 cm/s。在CAS方面,与基线相比,在12个月(p = 0.009)、18个月(p = 0.00001)和24个月(p = 0.005)时,ECA速度显著增加。在CEA组中,与基线相比,在1个月(p = 0.01)和6个月(p = 0.004)时,ECA速度显著下降。随访时CAS组有2例eca闭塞,CEA组无。在比较手术前的ICA和ECA速度时,没有发现显著差异。然而,在1个月、6个月和12个月的时间间隔,CAS组的ECA速度显著高于CEA组(p = 0.03、p = 0.001和p = 0.0004)。在研究期间,所有患者均未出现神经系统症状。结论虽然在CAS过程中发现了ECA进行性狭窄,但ECA通常不会闭塞。此外,没有相关的神经系统症状。因此,担心进行性ECA闭塞不应成为CAS的禁忌症。此外,对ECA覆盖范围的担忧不应阻止支架在CAS期间从ICA扩展到CCA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Differential effects of carotid artery stenting versus carotid endarterectomy on external carotid artery patency.
PURPOSE To determine the effect of stent coverage of the external carotid artery (ECA) after carotid artery stenting (CAS) compared to eversion endarterectomy of the ECA after carotid endarterectomy (CEA). METHODS The records of 101 CAS and 165 CEA procedures performed over 2 years were reviewed. Duplex velocities and history and physical examinations were taken prior to the procedure, at 1 month, and at 6-month intervals subsequently. CAS was performed by extending the stent across the internal carotid artery (ICA) lesion into the common carotid artery (CCA) thereby covering the ECA. CEA was performed with eversion endarterectomy of the ECA. RESULTS The mean peak systolic velocities (PSV) in the ICA pre-CAS and pre-CEA were 361 and 352 cm/s, respectively. In terms of CAS, there was a significant increase in ECA velocities versus baseline at 12 (p = 0.009), 18 (p = 0.00001), and 24 (p = 0.005) months. In the CEA group, there was a significant decrease in ECA velocities versus baseline at 1 (p = 0.01) and 6 (p = 0.004) months. There were 2 occluded ECAs in follow-up in the CAS group and none in the CEA group. No significant differences were noted when comparing preprocedural ICA or ECA velocities. However, at the 1-, 6-, and 12-month intervals, the ECA velocities in the CAS group were significantly higher than in the CEA group (p = 0.03, p = 0.001, and p = 0.0004, respectively). There were no neurological symptoms in any patients during the study period. CONCLUSION Although progressive stenosis of the ECA is noted during CAS, the ECA usually does not occlude. Furthermore, there are no associated neurological symptoms. Thus, apprehension for progressive ECA occlusion should not be a contraindication to CAS. In addition, concern for ECA coverage should not deter stent extension from the ICA to the CCA during CAS.
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