RÉSUMÉ
Objective To investigate the clinical effect and feasibility of interventional treatment of cervical artery stenosis in the elderly patients aged 75 years and over. Methods The data of 60cases aged 75 years or over who underwent interventional treatment of the cervical arteriostenosis involving carotid artery (CA), vertebral artery (VA) or proximal segment of the subclavian artery (SCA) were analyzed retrospectively. The clinical manifestations, imaging characteristics,interventional managements and follow-up results were recorded. Results In this cohort, the mean age was (78. 9±3.7) years (range from 75 to 89). The 50 patients (93.3%) complained of cerebral ischemic symptoms, and all the patients had concurrent diseases or risk factors, including hypertension, diabetes mellitus, coronary heart disease (CHD), stroke history, and so on. Digital subtraction angiography (DSA) data showed 55 cases (91.7%) had 2 or more cerebral arteries with a stenosis exceeding 30%. Among all cases, 84 lesions were treated with 84 stents, with a technical success rate of 98.8%. After stenting, the percent diameter stenosis of lesions decreased from a mean of (80.8 ± 12.9) % to (7.1 ± 9.5 ) %. The periprocedural and 30-day postoperative neurological complication rate was 8. 3 %, resulting in a permanent complication rate of 5 %. Clinical improvement rate was 87.5%. During a follow-up period of (36.7±26. 3) months (range from 5 to 99), there were 4 deaths: 2 died from myocardial infarction, 1 died from brain metastases of lung cancer and 1 died from cerebral hemorrhage. Cerebral infarction recurred in 3 cases. Imaging follow-up in 78. 3% of patients for 66 stents, including ultrasound, CTA, MRA or DSA, showed that the general in-stent restenosis rate was 9. 1%, and the restenosis rate of VA, CA and SCA was 21.7% (5/23), 2.6%and 0, respectively. Conclusions The results of this series suggest that interventional treatment ofcervical artery stenosis in the elderly patients aged 75 years and over is effective and feasible. In our experience, clinical comprehensive management and skillful technique of the operator are equally important for the elderly patients aged 75 years and over with high incidence of concurrent diseases or risk factors.
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Objective To investigate the mechanism of restenosis after carotid stent and balloon angioplasty for the Guangxi swines by intravascular ultrasound(IVUS). Methods Twelve Guangxi swines fed by a high cholesterol diet were randomly divided into two groups. Seven stents were implanted in the left carotid artery of six swines in the first group, and balloon angioplasty was performed in the left carotid artery of swines in the other group. Digital subtraction angiography(DSA) and IVUS were conducted respectively before and after the intervention and in the 13th week. Results IVUS found that the percentage of area stenosis in stent group was (18.31±7.79) % and in balloon group (37.28±7.89) % in the 13th week. The percentage of area restenosis in stent was obviously related to neointimal hyperplasia (r = 0.897, P<0.05), the percentage of area restenosis due to balloon angioplasty was markedly related to area decrease of external elastic lamina (r = 0.856, P<0.05). Conclusions The restenosis in stent was related to intimal hyperplasia of blood vessel,and restenosis after balloon angioplasty had some connection with area decrease of external elastic lamina.
RÉSUMÉ
ObjectiveTo summarize the prevention and treatment of complications of carotid angioplasty and stenting (CAS) in the elderly. Methods88 cases (≥60 years) who underwent carotid angioplasty and stenting were collected from our hospital. The prevention and treatment of complications were analyzed retrospectively. ResultsNinety-two self-expanding stents were placed in the 88 cases and the technical success rate was 100%. The degree of stenosis was significantly improved from 82.6% to 13.2%. All patients were followed up for 3-12 months. Carotid sinus reaction was observed in 23 cases (26.1%) and it was more often in ≥70 years group than in 60～69 years group (P＜0.05). Meanwhile, compared with the distance ＞10 mm, Carotid sinus reaition was more often in the distance ≤ 10 mm between carotid bifurcation and maximum stenotic lesion (P＜ 0.05). Hypertension occurred in 6 cases, cerebral hyperperfusion syndrome in 4 cases including 1 case of cerebral hemorrhage. There were cases with cerebral ischemia in 1 case, cerebralvaseular spasm in 4 cases, acute renal insufficiency in 3 cases and ecchymosis and hematoma at the puncture site in 7 cases. There were 3 cases of transient ischemic attack, 1 case of myocardial infarction, 1 case of cerebral hemorrhage, 2 cases of mild neurological deficits and no death occurred during the period of follow-up. ConclusionsThere is higher risk for elderly patients undergoing CAS, but careful preoperative preparation and properly treatment may avoid the occurrence of complications.
RÉSUMÉ
<p><b>OBJECTIVE</b>To report the initial application of brain protection device in the dilatation and stenting of atherosclerotic stenosis of the carotid and vertebral artery.</p><p><b>METHODS</b>Eighteen patients with 21 atherosclerotic stenoses of the carotid or vertebral artery underwent dilatation and/or stenting with brain protection device (filterwire or angioguard). The clinical results were summarized and the indispensability and feasibility of the device was discussed.</p><p><b>RESULTS</b>With the aid of brain protection device, endovascular dilatation and (or) stenting were performed in all the patients with 21 stenoses of the carotid or vertebral artery. The interventional manipulation was successful and no complications occurred.</p><p><b>CONCLUSIONS</b>Brain protection device is helpful to decrease the embolic complication caused by atherosclerotic plaque and thromboembolus and to increase the security of interventional therapy, during the dilatation and/or stenting of stenosis of the carotid or vertebral artery.</p>