经颈滤伞保护下颈动脉支架成形术的单中心经验

doi:10.3760/cma.j.cn101411-20231018-00034

科研成果详情

题名	经颈滤伞保护下颈动脉支架成形术的单中心经验
其他题名	A single-center experience of transcervical carotid artery stenting with embolic filter protection
作者	金文旭; 倪海真; 黄崇青; 潘乐门; 苏翔; 吕和平; 裘益辉; 杨法镜; 黄景勇; 虞冠锋
发表日期	2024-04-30
发表期刊	中华血管外科杂志影响因子和分区
语种	中文
原始文献类型	Periodical
关键词	颈动脉狭窄颈动脉支架成形术经颈滤伞保护下颈动脉支架成形术
其他关键词	Carotid artery stenosis ; Carotid artery stenting ; Transcervical carotid artery stenting with filter protection
摘要	目的:总结采用经颈滤伞保护下颈动脉支架成形术（TC-CAS）治疗颅外颈动脉狭窄的经验。方法:本研究为回顾性纵向研究。分析2020年12月至2023年9月温州医科大学附属第一医院血管外科应用TC-CAS治疗31例（32条颈动脉）颈动脉狭窄患者的临床资料。32条颈动脉病变均为颈内动脉起始段狭窄，其中重度狭窄25条，中度狭窄7条。31例患者中，CT血管造影示Ⅲ型弓10例，牛角弓2例，主动脉弓溃疡1例，重度钙化4例，混合斑块6例，颈总动脉迂曲7例，主髂动脉闭塞1例。观察和评估手术成功率、术后30 d 短暂性脑缺血发作（TIA）/卒中发生率、术后3 d内磁共振弥散加权成像（DW-MRI）检测到的新发脑缺血灶发生率以及外科并发症情况。结果:32条狭窄的颈动脉均经过TC-CAS成功开通（其中1例双侧颈动脉狭窄采取分期手术），残余狭窄程度均≤20%，手术成功率为100%。23例患者术后行DW-MRI，发现脑部新缺血灶4例（17.4%），其中3例无症状，1例出现小卒中，表现为短暂的意识淡漠，围术期卒中发生率为3.1%（1/32）。此外，2例患者术后早期出现创口血肿，经清创处理后成功治愈。所有患者均获得随访，术后中位随访时间为7.5（4.0，14.0）个月，随访期间无TIA或卒中发生。结论:TC-CAS治疗颈动脉狭窄，有利于降低CAS中导管接触主动脉弓斑块导致脑卒中的风险和避免对侧栓塞性卒中的发生，可考虑用于符合CAS适应证且存在通路解剖高风险因素的患者。
其他摘要	Objective:To summarize the experience in adopting transcervical carotid artery stenting (TC-CAS) for the treatment of extracranial carotid artery stenosis under the protection of embolic filter devices.Methods:This study was a retrospective cohort. A retrospective analysis of clinical data was conducted for 31 patients (32 carotid arteries) with confirmed carotid artery stenosis who underwent TC-CAS in Department of Vascular Surgery of the First Affiliated Hospital of Wenzhou Medical university between December 2020 and September 2023. Among the 32 arteries with carotid artery lesions, all were stenotic at the origin of the internal carotid artery, including 25 severe and 7 moderate stenoses. Among the 31 patients, there were 10 cases of Type Ⅲ arch shown on CT angiography, 2 cases of bovine arch, 1 case of aortic arch ulceration, 4 cases of severe calcification, 6 cases of mixed plaques, 7 cases of the carotid artery tortuosity, and 1 case of common iliac artery occlusion. The effectiveness assessment included procedural success rate, while safety assessment included the incidence of transient ischemic attack (TIA)/stroke within 30 days, the occurrence rate of new cerebral ischemic lesions detected by diffusion weighted magnetic resonance imaging (DW-MRI) within 72 hours after procedure, and local complications.Results:All 32 stenotic carotid arteries were successfully opened with TC-CAS (with one case undergoing staged surgery bilaterally), with a residual stenosis of ≤20% and a 100% procedural success rate. DW-MRI was performed in 23 patients after surgery, and new cerebral ischemic lesions were found in 4 cases(17.4%), of which 3 were asymptomatic, and 1 exhibited minor stroke manifested as transient loss of consciousness. The incidence of periprocedural stroke rate was 3.1% (1/32). In addition, two patients developed wound hematomas in the early postoperative period, which were successfully treated after debridement. The median follow-up time after surgery was 7.5 (4, 14) months, during which no TIA or strokes occurred.Conclusion:The TC-CAS treatment for carotid artery stenosis is beneficial in reducing the risk of cerebral infarction caused by catheter contact with aortic arch plaques during carotid artery stent placement. It also helps prevent the occurrence of contralateral embolic strokes. It is particularly suitable for patients who meet the indications for carotid artery stent placement but present with anatomical high-risk factors for carotid cannulation.
ISSN	2096-1863
卷号	09 期号:2 页码:118-121
DOI	10.3760/cma.j.cn101411-20231018-00034
页数	4
收录类别	万方 ; 维普
URL	查看原文
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/214826
专题	附属第一医院附属第一医院_血管外科
作者单位	温州医科大学附属第一医院血管外科，温州325000
第一作者单位	附属第一医院; 血管外科
第一作者的第一单位	附属第一医院
推荐引用方式 GB/T 7714	金文旭,倪海真,黄崇青,等. 经颈滤伞保护下颈动脉支架成形术的单中心经验[J]. 中华血管外科杂志,2024,09(2):118-121.
APA	金文旭., 倪海真., 黄崇青., 潘乐门., 苏翔., ... & 虞冠锋. (2024). 经颈滤伞保护下颈动脉支架成形术的单中心经验. 中华血管外科杂志, 09(2), 118-121.
MLA	金文旭,et al."经颈滤伞保护下颈动脉支架成形术的单中心经验".中华血管外科杂志 09.2(2024):118-121.