Identifying sex-specific differences in the carotid revascularisation literature:findings from a scoping review

Objective No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female patients.In this scoping review,we aimed to identify all randomised controlled trials(RCTs)that reported sex-specific outcomes for patients who underwent carotid revascularisation,and determine whether sufficient information is reported within these studies to assess short-term and long-term outcomes in female patients.Design,setting and participants We systematically searched Medline,Embase,Pubmed and Cochrane libraries for RCTs published between 1991 and 2020 that included female patients and compared either endarterectomy with stenting,or any revascularisation(endarterectomy or stenting)with medical therapy in patients with symptomatic high-grade(>50%)carotid stenosis.Results From 1537 references examined,27 eligible studies were identified.Sex-specific outcomes were reported in 13 studies.Baseline patient characteristics of enrolled female patients were reported in 2 of those 13 studies.Common outcomes reported included stroke and death,however,there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes.Sex-specific differences relating to the degree of stenosis and time from index event to treatment are largely limited to studies comparing endarterectomy to medical therapy.Adverse events were not reported by sex.Conclusions Only half of the previously published RCTs and systematic reviews report sex-specific outcomes.Detailed analyses on the results of carotid artery intervention for female patients with symptomatic stenosis are limited.

Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses:long-term outcomes

background and purpose We present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods 30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012.Data regarding presentation,follow-up,procedure details,complications and imaging follow-up were reviewed.All surviving patients underwent a phone interview to establish their current Modified Ranking Scales(MRS).results Stenoses of the intracranial vertebral artery(24 patients)and basilar artery(6 patients)were treated with stents(10 patients),angioplasty alone(13 patients)or both(5 patients).Two procedures failed.One patient(3.3%)died after the procedure,two had stroke(6.6%)and one a subarachnoid haemorrhage without ensuing deficit.Two patients(6.7%)had asymptomatic complications(dissection and pseudoaneurysm).The median clinical follow-up time was 7 years.Of the 29 patients who survived the procedure,6 died due to unrelated causes.Three patients(10%)had recurrent strokes and two(6.7%)a transient ischaemic attack in the posterior circulation.Two patients had subsequent middle cerebral artery strokes.Five(16.7%)patients had recurrent stenoses and three(10%)occlusions of the treated artery.Retreatment was performed in six patients,three(10%)with PTA and three(10%)with stenting.Current MRS scores were as follows:nine MRS 0,eight MRS 1,four MRS 2 and one MRS 4.Conclusions Long-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences.Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.

高危症状性颅内椎基底动脉狭窄患者血管内治疗的远期疗效

背景和目的探讨血管内治疗对症状性颅内后循环动脉狭窄患者的长期疗效。方法收集2006—2012年经血管内治疗的30例症状性、颅内后循环动脉狭窄超过70%的患者。回顾性分析患者的临床资料、手术过程、并发症、影像学和随访资料。所有存活的患者都接受了电话随访,以获取他们当前的改良Rankin量表(mRS)评分。结果30例患者中有24例为颅内椎动脉狭窄,6例为基底动脉狭窄。其中10例患者行支架植入术治疗,13例行经皮穿刺腔内血管成形术(PTA)治疗,还有5例患者同时行支架植入和PTA治疗。另有2例患者手术失败。术后死亡患者1例(3.3%),卒中患者2例(6.6%),1例为原发性蛛网膜下腔出血。2例患者(6.7%)出现无症状并发症(夹层和假性动脉瘤)。本研究的中位数临床随访时间为7年。在29例术后存活患者中,有6例死于其他无关因素。有3例患者(10%)出现卒中复发,2例(6.7%)为短暂性后循环缺血发作。2例患者出现继发性大脑中动脉卒中。5例患者(16.7%)再次出现动脉狭窄,其中3例为(10%)手术的动脉血管闭塞。有6例患者接受了二次手术治疗,其中3例患者(10%)行PTA治疗,另3例(10%)行支架植入术治疗。患者当前的mRS评分结果为:9例mRS评分为0分,8例mRS评分为1分,4例mRS评分为2分,1例mRS评分为4分。结论通过长期随访发现,高危症状性颅内后循环动脉狭窄患者经血管内治疗后,卒中复发率较低。选择合适的颅内椎动脉狭窄患者并予以血管内治疗可能使其获益。