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首页> 外文期刊>Neurosurgery >Low incidence of symptomatic strokes after carotid stenting without embolization protection devices for extracranial carotid stenosis: a single-institution retrospective review.
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Low incidence of symptomatic strokes after carotid stenting without embolization protection devices for extracranial carotid stenosis: a single-institution retrospective review.

机译：没有用于颅外颈动脉狭窄的栓塞保护装置的颈动脉支架置入术后症状性卒中的发生率低：单机构回顾性回顾。

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OBJECTIVE: Carotid angioplasty and stenting (CAS) remains the primary modality of treating individuals with carotid stenosis and significant comorbidities or anatomically difficult lesions. The use of embolization protection devices (EPD) has been mandated by the cerebrovascular community even though the ability of these devices to prevent symptomatic strokes is not supported by the current literature. Our goal was to assess the clinical and radiological outcomes of patients who underwent CAS without EPDs at our hospital from 1996 to 2006. METHODS: We performed a retrospective chart analysis of all patients who underwent CAS without EPDs at the Jefferson Hospital for Neuroscience in Philadelphia, PA. The clinical and angiographic outcomes of these patients were studied retrospectively using chart reviews and operative, angiographic, and radiological reports. The mean clinical and radiological follow-up period was 18.6 months. RESULTS: One hundred five patients (97.2%) had clinical follow-up at 1 month.During this period, the following complications were observed: cerebrovascular accidents in 2 patients (1.9%), myocardial infarctions in 2 patients (1.9%), femoral hematoma in 1 patient (0.9%), retroperitoneal hematomas in 3 patients (2.8%), and cervical carotid dissections in 4 patients (3.7%); 2 patients (1.9%) died. Seventy-six patients (80.9%) had a mean clinical follow-up period of 18.6 months. During this period, 2 patients (2.6%) had cerebrovascular accidents, 1 of which was fatal. The long-term morbidity and mortality rate was 2.6%. In the same follow-up period, the restenosis (>50% stenosis from baseline) rate was 9.2% (7 patients). Three (3.9%) of these patients went on to require repeat CAS. CONCLUSION: Our experience reveals that CAS can be performed safely with risks similar to those reported in series in which EPDs were used. Any procedure or device that adds risk and cost to the patient should be evaluated with a randomized, controlled trial to evaluate its efficacy, especially in situations inwhich published data provide conflicting results. The use of EPDs should be no exception to this paradigm.
机译：目的：颈动脉血管成形术和支架置入术（CAS）仍然是治疗颈动脉狭窄，合并症或解剖学上困难的个体的主要方式。尽管当前文献不支持栓塞保护装置（EPD）的使用，但脑血管界已要求这些装置预防症状性中风的能力。我们的目标是评估1996年至2006年在我院接受无EPD的CAS患者的临床和放射学结果。方法：我们对在费城的杰斐逊神经科学医院的所有未进行EPD的CAS患者进行了回顾性图表分析， PA使用图表审查以及手术，血管造影和放射学报告对这些患者的临床和血管造影结果进行回顾性研究。平均临床和影像学随访时间为18.6个月。结果：105例患者（97.2％）于1个月进行了临床随访，在此期间观察到以下并发症：2例（1.9％）脑血管意外，2例（1.9％）心肌梗塞，股骨血肿1例（0.9％），腹膜后血肿3例（2.8％），颈动脉夹层清扫术4例（3.7％）; 2例患者（1.9％）死亡。 76例患者（80.9％）平均临床随访期为18.6个月。在此期间，有2名患者（2.6％）发生脑血管意外，其中1人死亡。长期发病率和死亡率为2.6％。在相同的随访期内，再狭窄（狭窄程度较基线高> 50％）率为9.2％（7例患者）。这些患者中有三名（3.9％）继续需要重复CAS。结论：我们的经验表明，可以安全地进行CAS，其风险与使用EPD的系列报道的风险相似。任何给患者增加风险和成本的程序或设备，均应通过一项随机对照试验进行评估，以评估其疗效，尤其是在已发布数据提供矛盾结果的情况下。 EPD的使用也不例外。

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