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首页> 外文期刊>Advances in Interventional Cardiology: Postepy w Kardiologii Interwencyjnej >One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field
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One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field

机译：一只燕子不是一个夏天就能吞下的东西，但是很多燕子却能吞下它：用网状覆膜支架积累的几乎消除的围手术期和30天并发症的临床证据改变了颈动脉血运重建领域

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Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay – but it does not abolish – CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint. Nevertheless CAS – using a widely open-cell, first-generation stent and first-generation (distal/filter) neuroprotection – has been criticised for its relative excess of (mostly minor) strokes by 30 days, a significant proportion of which were post-procedural. Atherosclerotic plaque protrusion through conventional carotid stent struts, confirmed on intravascular imaging, has been implicated as a leading mechanism of the relative excess of strokes with CAS vs. CEA, including delayed strokes with CAS. Different designs of mesh-covered carotid stents have been developed to prevent plaque prolapse. Several multi-centre/multi-specialty clinical studies with CGurad MicroNet-Covered Embolic Prevention Stent System (EPS) and RoadSaver/Casper were recently published and included routine DW-MRI cerebral imaging peri-procedurally and at 30 days (CGuard EPS). Data from more than 550 patients in mesh-covered carotid stent clinical studies to-date show an overall 30-day complication rate of ~1% with near-elimination of post-procedural events. While more (and long-term) evidence is still anticipated, these results – taken together with optimised intra-procedural neuroprotection in CAS (increased use of proximal systems including trans-carotid dynamic flow reversal) and the positive 12-month mesh-covered stent data reports in 2017 – are transforming the carotid revascularisation field today. Establishing effective algorithms to identify the asymptomatic subjects at stroke risk despite OMT, and large-scale studies with mesh-covered stents including long-term clinical and duplex ultrasound outcomes, are the next major goals.
机译：动脉粥样硬化性颈动脉狭窄（CS）仍然是急性缺血性中风的常见原因。优化的医学治疗（OMT）是CS中的一线治疗方式，可以减少或延迟–但不会消除– CS相关中风。根据当前的AHA / ASA和ESC / ESVS / ESO指南，在一级和二级卒中预防中，对于CS血管重建术，颈动脉支架置入术（CAS）是颈动脉内膜切除术（CEA）的无创替代方法。对有症状和无症状CS的患者进行的CREST试验十年随访证实，主要终点是CAS和CEA平衡。然而，由于使用了广泛开放的第一代支架和第一代（远端/过滤器）神经保护功能，CAS被批评为卒中在30天后相对过剩（大部分是次要的），其中很大一部分发生在术后。程序。通过血管内影像证实的通过常规颈动脉支架支柱的动脉粥样硬化斑块突出，被认为是CAS与CEA相对卒中相对过量的主要机制，包括CAS延迟卒中。已经开发了不同设计的网状覆盖的颈动脉支架，以防止斑块脱出。最近发表了一些使用CGurad MicroNet覆盖的栓塞预防支架系统（EPS）和RoadSaver / Casper进行的多中心/多专业临床研究，包括围手术期和30天常规DW-MRI脑成像（CGuard EPS）。迄今为止，来自550例网状覆盖颈动脉支架患者的数据显示，术后30天的总并发症发生率约为1％，几乎消除了术后事件。尽管仍有望获得更多（和长期的）证据，但这些结果与CAS中的最佳过程内神经保护（增加使用近端系统，包括经颈动脉动态血流逆转）和阳性的12个月网状覆膜支架相结合2017年数据报告–如今正在改变颈动脉血运重建领域。下一个主要目标是建立有效的算法，以识别尽管发生OMT仍无卒中风险的无症状受试者，并使用网状覆盖支架进行大规模研究，包括长期临床和双工超声结果。

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