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首页> 外文期刊>Journal of vascular surgery >Alert for increased long-term follow-up after carotid artery stenting: results of a prospective, randomized, single-center trial of carotid artery stenting vs carotid endarterectomy.
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Alert for increased long-term follow-up after carotid artery stenting: results of a prospective, randomized, single-center trial of carotid artery stenting vs carotid endarterectomy.

机译：提示在颈动脉支架置入术后长期随访增加：一项关于颈动脉支架置入术与颈动脉内膜切除术的前瞻性，随机，单中心试验结果。

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BACKGROUND: Carotid endarterectomy (CEA) has been shown to be effective in stroke prevention for patients with symptomatic or asymptomatic carotid artery stenosis. Although several prospective randomized trials indicate that carotid artery stenting (CAS) is an alternative but not superior treatment modality, there is still a significant lack of long-term data comparing CAS with CEA. This study presents long-term results of a prospective, randomized, single-center trial. METHODS: Between August 1999 and April 2002, 87 patients with a symptomatic high-grade internal carotid artery stenosis (70%) were randomized to CAS or CEA. After a median observation time of 66 +/- 14.2 months (CAS) and 64 +/- 12.1 months (CEA), 42 patients in each group were re-evaluated retrospectively by clinical examination and documentation of neurologic events. Duplex ultrasound imaging was performed in 61 patients (32 CAS, 29 CEA), and patients with restenosis 70% were re-evaluated by angiography. RESULTS: During the observation period, 23 patients (25.2%) died (10 CAS, 13 CEA), and three were lost to follow up. The incidence of strokes was higher after CAS, with four strokes in 42 CAS patients vs none in 42 CEA patients. One transient ischemic attack occurred in each group. A significantly higher rate of restenosis 70% (6 of 32 vs 0 of 29) occurred after CAS compared with CEA. Five of 32 CAS patients (15.6%) presented with high-grade (70%) restenosis as an indication for secondary intervention or surgical stent removal, and three presented with neurologic symptoms. No CEA patients required reintervention (P .05 vs CAS). A medium-grade (70%) restenosis was detected in eight of 32 CAS patients (25%) and in one of 29 CEA patients (3.4%). In five of 32 CAS (15.6%) and three of 29 CEA patients (10.3%), a high-grade stenosis of the contralateral carotid artery was observed and treated during the observation period. CONCLUSION: The long-term results of this prospective, randomized, single-center study revealed a high incidence of relevant restenosis and neurologic symptoms after CAS. CEA seems to be superior to CAS concerning the development of restenosis and significant prevention of stroke. However, the long-term results of the ongoing multicenter trials have to be awaited for a final conclusion.
机译：背景：颈动脉内膜切除术（CEA）已被证明对有症状或无症状的颈动脉狭窄患者的中风预防有效。尽管一些前瞻性随机试验表明，颈动脉支架置入术（CAS）是一种替代方法，但不是优越的治疗方式，但仍然存在与CAS与CEA进行比较的长期数据的严重缺乏。这项研究提供了一项前瞻性，随机，单中心试验的长期结果。方法：1999年8月至2002年4月，将87例症状性高级别颈内动脉狭窄（> 70％）患者随机分为CAS或CEA。在中位观察时间为66 +/- 14.2个月（CAS）和64 +/- 12.1个月（CEA）之后，通过临床检查和神经系统事件的记录对每组中的42例患者进行了回顾性评估。对61例患者（32 CAS，29 CEA）进行了双重超声成像，并通过血管造影重新评估了再狭窄> 70％的患者。结果：在观察期内，有23例患者（25.2％）死亡（10例CAS，13例CEA），另有3例失访。 CAS后中风的发生率较高，42例CAS患者中有4例中风，而42例CEA患者中无。每组发生一次短暂性脑缺血发作。与CEA相比，CAS后发生的再狭窄率> 70％（32中的6比29中的0）更高。 32例CAS患者中有5例（15.6％）表现为高度再狭窄（> 70％），以作为二次介入或手术支架摘除的指征，另外3例表现出神经系统症状。没有CEA患者需要再次干预（P <.05 vs CAS）。在32例CAS患者中有8例（25％）和29例CEA患者中有1例（3.4％）检测到中度（<70％）再狭窄。在观察期间，在32例CAS的5例（15.6％）和29例CEA的3例（10.3％）中观察到了对侧颈动脉的高度狭窄。结论：这项前瞻性，随机，单中心研究的长期结果显示，CAS后相关再狭窄和神经系统症状的发生率很高。在再狭窄的发展和中风的预防方面，CEA似乎优于CAS。但是，正在进行的多中心试验的长期结果必须等待最终结论。

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