The Clinical Outcomes of 75 Consecutive Patients with Cervical Carotid Artery Stenosis Treated by Carotid Artery Stenting

Objective

The purpose of this study was to analyze the clinical outcome of 75 consecutive patients with cervical carotid artery stenosis and who were treated by carotid artery stenting (CAS) only.

Methods

From February 2003 to June 2008, there were 78 stents placed in 75 symptomatic patients (mean age : 67.3 years); 69 patients had carotid stenosis ≥70%, and 6 patients had asymptomatic stenosis ≥80%. No carotid endarterectomy (CEA) was performed during the same period. The patients were clinically followed-up for a mean of 20.1 months.

Results

The procedures were technically successful in all cases. Three (3.8%) patients had procedure-related complications. During the 30-day postprocedural period, there were no restenosis or major stroke. Minor stroke was noticed in 3 (3.8%) patients and 1 (1.3%) of the 75 patients suddenly expired 2 days after discharge. There were no new neurological symptoms that developed during the clinical follow-up period. The results of our series were not inferior to those the previously published in CAS studies, and in fact they were better.

Conclusion

Our results suggest that CAS may be safe and useful for the treatment of cervical carotid artery stenosis when it is used as the first line treatment in those institutions that lack enough experience with CEA.     

无症状性颈动脉狭窄患者不同治疗方式后的临床结局

目的 探讨无症状性颈动脉狭窄（asymptomatic carotid artery stenosis,ACAS）患者药物治疗和介入治疗后的临床结局。      

颈动脉支架成形术与药物治疗颈动脉狭窄的对比研究

目的 分析颈动脉支架成形术（CAS）与药物治疗颈动脉狭窄的疗效，并评价其安全性。方法 2003年11月至2006年3月采用颈动脉支架成形术治疗颈内动脉狭窄（狭窄率≥50％）21例,于围手术期进行抗血小板治疗及控制危险因素。单纯药物治疗组53例，药物治疗方案同治疗组。临床随访6～28个月。结果 21例手术操作完全成功，术后残余狭窄＜30％，术中3例患者出现一过性心率减慢、血压下降，2例出现颈内动脉远端血管痉挛，治疗后好转；术后未发生新的卒中，颈动脉超声未显示再狭窄。药物治疗组随访期间，5例患者再发卒中，颈动脉超声检查发现14例患者狭窄程度加重，其中2例血管造影证实颈内动脉完全闭塞。结论 与药物治疗组比较，CAS治疗颈内动脉狭窄可以提高患者的生活质量，而且比较安全，短期疗效较好，但有待大样本研究结果证实     

Prolonged Autonomic Fluctuation Derived from Parasympathetic Hypertonia after Carotid Endarterectomy but not Stenting

Background

Carotid endarterectomy (CEA) is a standard treatment for carotid artery stenosis, but the incidence after periprocedural myocardial infarction (MI) is not negligible. The mechanism for the higher risk of MI following CEA compared with the carotid artery stenting (CAS) is unclear. We hypothesized that it may be explained by different autonomic nervous responses.

颈动脉支架置入术后支架内血栓形成研究进展

颈动脉支架内血栓形成是颈动脉支架置入术后的严重并发症,可导致患者严重瘫痪甚至死亡。然而迄今为止,针对颈动脉支架内血栓形成,仍没有统一的治疗方式。虽然有很多病例报道了颈动脉支架内血栓形成的处理方法,但是仍缺少随机双盲试验或大型临床试验来证实其可靠性、安全性。在临床上,与手术操作相关的颈动脉支架内血栓形成,是颈动脉支架内血栓形成的最主要原因。除此之外,抗血小板治疗不充分或停止抗血小板治疗、高凝状态、抗血小板药物抵抗也可导致颈动脉支架内血栓形成。目前,抗血小板及抗凝治疗、溶栓治疗、颈动脉内膜剥脱术及颈动脉支架术、机械取栓或血栓抽吸治疗等均有报道,无论何种治疗方式,使患者快速获得血管再通是颈动脉支架内血栓形成治疗的关键。     

分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄的疗效与安全性观察

目的 观察分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的疗效及安全性。
方法 回顾性分析2017年1-12月在西安交通大学第一附属医院神经内科连续住院的颈内动脉次全
闭塞伴对侧颈内动脉狭窄患者的临床资料。采用分期治疗的方法，一期使用小球囊扩张次全闭塞侧
颈内动脉，间隔2周后进行二期支架置入。观察手术技术成功率，手术成功指一期小球囊扩张后狭窄
率减小，局部无夹层，且二期支架置入位置良好，残余狭窄率≤30%，前向血流mTICI 3级；围手术期
并发症（包括高灌注综合征、脑梗死、TIA等）及死亡情况；随访1个月、3个月、6个月及3年的mRS评分，
以及心脑血管事件和全因死亡。
结果 共纳入7例颈内动脉次全闭塞患者，平均年龄63.0±3.4岁，男性6例；其中6例为左侧，6例合
并对侧颈内动脉狭窄≥50%。手术技术成功率100%（7/7），所有患者均未发生围手术期并发症及死
亡。1个月随访时1例患者mRS评分为1分，其他6例均为0分，其余时间点所有患者均为0分，3年随访时1
例患者于术后1年发生冠心病。
结论 分期支架治疗在颈内动脉次全闭塞伴对侧颈动脉狭窄患者中相对安全，并对颈内动脉狭窄
的改善明显。     

分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄的疗效与安全性观察

目的 观察分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的疗效及安全性。方法 回顾性分析2017年1-12月在西安交通大学第一附属医院神经内科连续住院的颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的临床资料。采用分期治疗的方法,一期使用小球囊扩张次全闭塞侧颈内动脉,间隔2周后进行二期支架置入。观察手术技术成功率,手术成功指一期小球囊扩张后狭窄率减小,局部无夹层,且二期支架置入位置良好,残余狭窄率≤30%,前向血流mTICI 3级;围手术期并发症（包括高灌注综合征、脑梗死、TIA等）及死亡情况;随访1个月、3个月、6个月及3年的mRS评分,以及心脑血管事件和全因死亡。结果 共纳入7例颈内动脉次全闭塞患者,平均年龄63.0±3.4岁,男性6例;其中6例为左侧,6例合并对侧颈内动脉狭窄≥50%。手术技术成功率100%（7/7）,所有患者均未发生围手术期并发症及死亡。1个月随访时1例患者mRS评分为1分,其他6例均为0分,其余时间点所有患者均为0分,3年随访时1例患者于术后1年发生冠心病。结论 分期支架治疗在颈内动脉次全闭塞伴对侧颈动脉狭窄患者中相对安全,并对颈内动脉狭窄的改善明显。     

Delayed Cerebral Hyperperfusion Syndrome Three Weeks after Carotid Artery Stenting Presenting as Status Epilepticus

Cerebral hyperperfusion syndrome (CHS) is increasingly recognized as an uncommon, but serious, complication subsequent to carotid artery stenting (CAS) and carotid endarterectomy (CEA). The onset of CHS generally occurs within two weeks of CEA and CAS, and a delay in the onset of CHS of over one week after CAS is quite rare. We describe a patient who developed CHS three weeks after CAS with status epilepticus.