Frequency and management of recurrent stenosis after carotid artery stent implantation

被引:53
作者
Levy, EI
Hanel, RA
Lau, T
Koebbe, CJ
Levy, N
Padalino, DJ
Malicki, KM
Guterman, LR
Hopkins, LN
机构
[1] SUNY Buffalo, Dept Neurosurg, Sch Med & Biomed Sci, Buffalo, NY 14209 USA
[2] SUNY Buffalo, Toshiba Stroke Res Ctr, Sch Med & Biomed Sci, Buffalo, NY 14209 USA
[3] SUNY Buffalo, Dept Radiol, Sch Med & Biomed Sci, Buffalo, NY 14209 USA
[4] Millard Gates Hosp, Kaleida Hlth Syst, Doppler Lab, Buffalo, NY USA
[5] Univ Pittsburgh, Med Ctr, Dept Neurosurg, Pittsburgh, PA USA
关键词
carotid artery; stent; in-stent stenosis;
D O I
10.3171/jns.2005.102.1.0029
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. To determine the rate of hemodynamically significant recurrent carotid artery (CA) stenosis after stent-assisted angioplasty for CA occlusive disease, the authors analyzed Doppler ultrasonography data that had been prospectively collected between October 1998 and September 2002 for CA stent trials. Methods. Patients included in the study participated in at least 6 months of follow-up review with serial Doppler studies or were found to have elevated in-stent velocities (> 300 cm/second) on postprocedure Doppler ultrasonograms. Hemodynamically significant (greater than or equal to 80%) recurrent stenosis was identified using the following Doppler criteria: peak in-stent systolic velocity at least 330 cm/second, peak in-stent diastolic velocity at least 130 cm/second, and peak internal carotid artery/common carotid artery velocity ratio at least 3.8. Follow-up studies were obtained at approximate fixed intervals of 1 day, 1 month, 6 months, and yearly. Angiography was performed in the event of recurrent symptoms, evidence of hemodynamically significant stenosis on Doppler ultrasonography, or both. Treatment was repeated because of symptoms, angiographic evidence of severe (greater than or equal to 80%) recurrent stenosis, or both of these. Stents were implanted in 142 vessels in 138 patients (all but five patients were considered high-risk surgical candidates and 25 patients were lost to follow-up review). For the remaining 112 patients (117 vessels), the mean duration of Doppler ultrasonography follow up was 16.42 +/- 10.58 months (range 4-54 months). Using one or more Doppler criteria, severe (greater than or equal to 80%) in-stent stenosis was detected in six patients (5%). Eight patients underwent repeated angiography. Six patients (three with symptoms) required repeated intervention (in four patients angioplasty alone; in one patient conventional angioplasty plus Cutting Balloon angioplasty; and in one patient stent-assisted angioplasty). Conclusions. In a subset of primarily high-risk surgical candidates treated with stent-assisted angioplasty, the rates of hemodynamically significant restenosis were comparable to surgical restenosis rates cited in previously published works. Treatment for recurrent stenosis incurred no instance of periprocedure neurological morbidity.
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页码:29 / 37
页数:9
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