Background and Purpose:Carotid angioplasty and stenting(CAS) has emerged as a potential alternative to endarterectomy(CEA) for the treatment of carotid arter y disease. Aside from the periprocedural complication rates...Background and Purpose:Carotid angioplasty and stenting(CAS) has emerged as a potential alternative to endarterectomy(CEA) for the treatment of carotid arter y disease. Aside from the periprocedural complication rates, the benefits of CAS will be affected by the incidence of recurrent carotid stenosis. Methods:We co nducted a systematic analysis of all peer-reviewed studies reporting on the rat e of restenosis (≥50%) after CAS based on duplex ultrasound or angiography tha t were published between January 1990 and July 2004. We identified 34 studies th at reported on a total of 4185 patients with a follow-up of 3814 arteries over a median of 13 months (range, 6 to 31 months).The ultrasound criteria and the lo wer thresholds for defining a recurrent stenosis were very heterogeneous. Result s:The cumulative restenosis rates after 1 and 2 years were ≈6%and 7.5%in tho se studies, which used a lower restenosis threshold≥50%to 70%and ≈4%in the first 2 years after CAS in those studies, which used a lower restenosis threshol d > 70%to 80%.Conclusions:In reviewing the current literature, the early rest enosis rates after CAS compare well with those reported for CEA. However, this a nalysis of the peer-reviewed literature also indicates that the early restenosi s rates after CAS might be higher than previously suggested in observational sur veys.Therefore, an active follow-up of all stented arteries seems to be warrant ed. Moreover, the bulk of endovascular data are derived from small studies with short follow-up periods so that the long-term durability of CAS still needs to be established in large trials. Ideally, these studies should use a clear and u niform definition of restenosis and identical follow-up schedules.展开更多
文摘Background and Purpose:Carotid angioplasty and stenting(CAS) has emerged as a potential alternative to endarterectomy(CEA) for the treatment of carotid arter y disease. Aside from the periprocedural complication rates, the benefits of CAS will be affected by the incidence of recurrent carotid stenosis. Methods:We co nducted a systematic analysis of all peer-reviewed studies reporting on the rat e of restenosis (≥50%) after CAS based on duplex ultrasound or angiography tha t were published between January 1990 and July 2004. We identified 34 studies th at reported on a total of 4185 patients with a follow-up of 3814 arteries over a median of 13 months (range, 6 to 31 months).The ultrasound criteria and the lo wer thresholds for defining a recurrent stenosis were very heterogeneous. Result s:The cumulative restenosis rates after 1 and 2 years were ≈6%and 7.5%in tho se studies, which used a lower restenosis threshold≥50%to 70%and ≈4%in the first 2 years after CAS in those studies, which used a lower restenosis threshol d > 70%to 80%.Conclusions:In reviewing the current literature, the early rest enosis rates after CAS compare well with those reported for CEA. However, this a nalysis of the peer-reviewed literature also indicates that the early restenosi s rates after CAS might be higher than previously suggested in observational sur veys.Therefore, an active follow-up of all stented arteries seems to be warrant ed. Moreover, the bulk of endovascular data are derived from small studies with short follow-up periods so that the long-term durability of CAS still needs to be established in large trials. Ideally, these studies should use a clear and u niform definition of restenosis and identical follow-up schedules.
文摘颈动脉狭窄的病因包括动脉粥样硬化、动脉夹层分离、纤维肌性发育不良、大动脉炎和放射性损伤等，是缺血性脑血管病的重要病理学基础。业已证实，颈动脉内膜切除术（carotid endarterectomy,CEA）能够显著降低中到重度有症状颈动脉狭窄患者的缺血性卒中风险，对于无症状重度狭窄患者，CEA也有一定益处。近年来，随着血管内介入治疗技术的不断成熟和发展，血管成形和支架置入术（carotid angioplasty and stenting,CAS）在颈动脉狭窄中的应用越来越广泛，成为CEA的一种替代治疗手段。
