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首页> 外文期刊>Vascular and endovascular surgery >Multicenter Experience of Surgical Explantation of Carotid Stents for Recurrent Stenosis
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Multicenter Experience of Surgical Explantation of Carotid Stents for Recurrent Stenosis

机译：颈动脉支架手术治疗复发性狭窄的多中心经验

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Objective: A significant cohort of patients who have undergone carotid artery stenting (CAS) will have in-stent restenosis (ISR). The optimal management of symptomatic or severe ISR remains poorly defined. The purpose of this study was to describe the indications, treatment, and mid-to long-term outcomes of patients undergoing CAS explantation for ISR. Methods: All patients undergoing internal carotid artery stent explantation with carotid artery reconstruction at Mayo Clinic Rochester, Dartmouth-Hitchcock Medical Center, and Beth-Israel Deaconess Medical Center from 2003 to 2013 were retrospectively reviewed. Isolated common carotid artery stents were excluded. Demographics, comorbidities, indications for explantation, operative details, and perioperative and postoperative outcomes were reviewed. Results: Over the study interval, a total of 971 patients underwent carotid stenting across the 3 centers. Of these, 8 patients ultimately underwent CAS explantation with carotid artery reconstruction. Mean age was 69 years and 5 patients were male. Index stent placement was for symptomatic stenosis in 4 patients, asymptomatic restenosis after endarterectomy in 2 patients, asymptomatic high lesion in 1 patient, and asymptomatic critical stenosis in 1 patient. Indications for explantation were symptomatic ISR in 4 patients and asymptomatic severe ISR in 4 patients. Method of repair was stent explantation and patch angioplasty in 5 and en bloc carotid resection with bypass in 3 patients. There were no perioperative neurologic events or cranial nerve injuries. At a mean follow-up of 38.7 months, there were 2 late disabling ipsilateral strokes (14.4 months and 19.1 months). Conclusion: A significant cohort of patients who have undergone CAS will have ISR. Although excellent perioperative results after surgical explantation can be obtained, this patient subgroup remains at risk for late neurologic events. Appropriate patient selection and diligent long-term follow-up are mandated to obtain optimal outcomes.
机译：目的：大量接受颈动脉支架置入术（CAS）的患者将发生支架内再狭窄（ISR）。有症状或严重ISR的最佳治疗方法仍然不明确。这项研究的目的是描述接受ISR CAS移植的患者的适应症，治疗和中长期结果。方法：回顾性分析2003年至2013年在梅奥诊所罗切斯特，达特茅斯-希区柯克医学中心和贝思-以色列女执事医学中心接受颈内动脉支架植入手术并重建颈动脉的所有患者。排除了孤立的颈总动脉支架。回顾了人口统计学，合并症，外植适应症，手术细节以及围手术期和术后结果。结果：在研究间隔内，共有971名患者在3个中心接受了颈动脉支架置入术。其中，最终有8例患者接受了颈动脉重建术并进行了CAS移植。平均年龄为69岁，其中5例为男性。索引支架置入术用于有症状的狭窄4例，内膜切除术后无症状的再狭窄2例，无症状的高病变1例，无症状的严重狭窄1例。外植指征为有症状的ISR 4例和无症状的严重ISR 4例。修复方法为5例行支架植入术和斑块血管成形术，3例行全颈颈动脉切除术。没有围手术期神经系统事件或颅神经损伤。平均随访38.7个月，有2例晚期同侧残疾卒中（分别为14.4个月和19.1个月）。结论：大量接受CAS的患者将患有ISR。尽管可以在外科植入手术后获得良好的围手术期效果，但是该患者亚组仍处于晚期神经系统事件的风险中。为了获得最佳结果，必须进行适当的患者选择和勤奋的长期随访。

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