Transfemoral filter-protected carotid artery stenting (CAS) has emerged as a valid alternative to carotid surgery. To overcome the drawbacks of femoral access for CAS and reduce embolic load, some have proposed cervical access with internal carotid artery (ICA) flow reversal. In a series of patients at high risk for femoral access who underwent transcervical CAS with ICA flow reversal, we report clinical outcome and intraoperative embolization rates measured by diffusion-weighted magnetic resonance imaging (DW-MRI). A series of 48 patients were selected for transcervical CAS with carotid flow reversal from September 2004 to July 2007. The indications used for this technique were age >or=80 years, severe aortic and epiaortic vessel tortuosity, widespread calcification of aortic arch or epiaortic vessels, severe aortoiliac occlusive disease, large abdominal aortic aneurysm, and aortobifemoral prosthesis. During the procedure, no adjunctive maneuvers such as external carotid artery balloon occlusion were used. Of the 48 patients, 43 underwent preoperative and postoperative cerebral DW-MRI. The death/stroke rate in the 48 patients was 2.1% (one transient ischemic attack, one minor stroke, and no deaths). None of the procedures led to carotid dissections or access-site complications. Of the 43 patients who underwent DW-MRI, 16 new ischemic lesions were disclosed in six patients (13.9%), four (9.3%) of whom remained asymptomatic. All ischemic lesions were ipsilateral to the treated carotid artery. In patients at high risk for the transfemoral approach, transcervical carotid stenting with flow reversal achieves good technical and clinical results and seems able to reduce the incidence of postoperative DW-MRI ischemic lesions previously reported for transfemoral filter-protected CAS.

译文

:经股动脉滤器保护的颈动脉支架置入术(CAS)已成为颈动脉手术的有效替代方法。为了克服CAS的股骨入路的缺点并减少栓塞负荷,一些人提出了颈内动脉(ICA)逆转的颈椎入路。在一系列接受经颈CAS并进行ICA逆转的高风险股骨入路患者中,我们报告了通过弥散加权磁共振成像(DW-MRI)测量的临床结局和术中栓塞率。从2004年9月至2007年7月,选择48例经颈颈动脉血流逆转的CAS患者。该技术的适应症是年龄>或= 80岁,主动脉和epi主动脉曲折严重,主动脉弓或主动脉弓钙化广泛,严重的主动脉闭塞性疾病,大腹主动脉瘤和主动脉分娩假体。在该过程中,没有使用辅助措施,例如颈外动脉球囊阻塞。在48例患者中,有43例接受了术前和术后脑DW-MRI检查。 48例患者的死亡率/中风率为2.1%(1次短暂性脑缺血发作,1次轻度中风,无死亡)。这些程序均未导致颈动脉夹层或进入部位并发症。在接受DW-MRI检查的43例患者中,有6例(13.9%)出现16例新的缺血性病变,其中4例(9.3%)无症状。所有缺血性病变均在治疗的颈动脉同侧。对于经股动脉入路高风险的患者,经颈逆流置入颈动脉支架取得了良好的技术和临床效果,并且似乎能够减少先前报道的经股动脉滤器保护的CAS术后DW-MRI缺血性病变的发生。

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