ABSTRACT
Objective To assess the efficacy and safety of carotid artery stenting and medical therapy in patients with symptomatic extracranial carotid stenosis ,we comparisoned and analysised clinical outcome of the two methods.Methods A retrospective analysis was conducted of a total of 265 patients with symptomatic extracranial carotid stenosis who had full follow-up data in our hospital from 2001 to 2003. 160 patients were treated by means of endovascular stent , 105 patients were received aspirin and ticlopidine. Results There was a technical success of 100% with 160 carotid arteries treated. The average stenosis rate was reduced from( 79.5 ?14.6)% before treatment to ( 11.2? 7.8)% after stent-assisted angioplasty. The diameter of carotid artery was increased from ( 1.5 ?0.6)mm to ( 4.1 ?0.4)mm (P0.05).There was 1 death in medical group,no deaths occurred in stent group. During the follow-up (mean 13.5 months) period the ipsilateral stroke rate was 0.63%(n=1),and the total stroke and death was 1.25%(n=2) in stent group. The ipsilateral stroke rate was 3.81%(n=4),and the total stroke and death was 4.76%(n=5) in medical group during the follow-up period.Conclusions Carotid angioplasty and stenting is more feasible and safe for the treatment of symptomatic extracranial carotid stenosis than medical therapy,the total perioperative stroke and mortality rate is low. At long-term follow-up,the recurrent stroke and restenosis rate is low.
ABSTRACT
Objective Hyperperfusion syndrome is a rare and devastating complication of carotid artery angioplasty and stenting(CAS).We report the clinical character of this complication in a patient undergoing CAS.Methods This report is a retrospective review of one case with severe extracranial carotid stenosis of carotid angioplasty and stenting performed on March,2004.We analysesed the clinical and imagining character of this hyperperfusion syndrome related to CAS. Results The patient with subtotal occlusion of the right internal carotid artery had a 10-mm lesion treated percutaneously with implantation of 2 stents (Precise 6?30mm、10?40mm) under general anesthesia.The stenosis was postdilated with a 5?20mm balloon. Postprocedural angiography showed no significant stenosis, the blood pressure varied between 230～300/100～130mmHg,the heart rate decreased to 55/min. An urgent brain CT revealed extensive hemorrhage with 80ml in the right basal ganglia. Surgical evacuation was performed urgently under general anesthesia.After operation the patient presented with vegetative status.Conclusions Intracerebral hemorrhage is related to cerebral hyperperfusion after CAS.One of risk factors for hyperperfusion syndrome is of severe ipsilateral stenosis of 90% severity or greater with collateral carotid stenosis. Peri-and postintervention TCD monitoring is mandantory, TCD can be identified patients at risk of cerebral hyperperfusion,to decrease postintervention hemorrhage.