Interactive CardioVascular and Thoracic Surgery (2018) 1–6
Zahra Hasania, RudolfW.M. Keunena,*, De′nes L.J. Tavya, ArneMoscha, Barry B. Mook-Kanamoria,Sebastiaan F.T.M. De Bruijna, Ali M. Keyhan-Falsafib, Gerard J.F. Hoohenkerkb, Gayleen Stephensb, Eric Teeuwsb,Jan van Alphenc, Hans van Overhagend, Frank E.E. Treurnietd, Lucas vanDijkd and Paulien M. van Kampene
a Department of Neurology and Clinical Neurophysiology, Haga Teaching Hospitals, The Hague, Netherlands
b Department of Cardiosurgery, Haga Teaching Hospitals, The Hague, Netherlands
c Department of Cardioanaesthesiology, Haga Teaching Hospitals, The Hague, Netherlands
d Department of Intervention Radiology, Haga Teaching Hospitals, The Hague, Netherlands
e Department of Biostatistics, Haga Teaching Hospitals, Netherlands
* Corresponding author. Department of Neurology, Haga Teaching Hospitals, Leyweg 275, 2545 CH The Hague, Netherlands. Tel: +31-70-2100000;
e-mail: r.keunen@hagaziekenhuis.nl (R.W.M. Keunen).
Abstract
OBJECTIVES: Reducing the rate of postoperative stroke after cardiac surgery remains challenging, especially in patients with occlusive cerebrovascular disease. Angioplasty in all patients with high-grade carotid artery stenosis has not been shown to be effective in reducing the post-surgical stroke rate. In this study, we present the initial results of a different approach using selective carotid angioplasty only inpatients with poor intracranial collaterals.
METHODS: We conducted a single-centre study to assess the safety of this procedure. The postangioplasty complication rate of the study group was compared to that of patients who were scheduled for symptomatic carotid artery angioplasty. To determine the effectiveness of this procedure, the post-cardiac surgery complication rate of the study group was compared with that of the matched case controls.
RESULTS: Twenty-two patients were treated with selective carotid angioplasty without developing persistent major neurological complications.All patients except 1 patient subsequently underwent surgery without developing persistent major neurological disabilities. Two patients died of cardiogenic shock within 30 days.
CONCLUSIONS: Selective carotid angioplasty prior to cardiac surgery in patients with a presumed high risk of stroke was relatively safe and effective in this study group. Although this strategy does not prevent stroke in these high-risk patients, data suggest that this approach shifts the postoperative type of stroke from a severe haemodynamic stroke towards a minor embolic stroke with favourable neurological outcomes. Larger studies are needed to determine whether this strategy can effectively eliminate the occurrence of haemodynamic strokeafter cardiac surgery.
摘要：
目的：降低心臟手術(shù)后的中風(fēng)發(fā)生率仍然具有挑戰(zhàn)性，尤其是對(duì)于閉塞性腦血管疾病的患者。尚無(wú)所有高級(jí)別頸動(dòng)脈狹窄患者的血管成形術(shù)能有效降低術(shù)后卒中發(fā)生率。在這項(xiàng)研究中，我們僅針對(duì)顱內(nèi)側(cè)支較差的住院患者，介紹了使用選擇性頸動(dòng)脈血管成形術(shù)的另一種方法的初步結(jié)果。
方法：我們進(jìn)行了單中心研究，以評(píng)估該程序的安全性。將研究組的血管成形術(shù)后并發(fā)癥發(fā)生率與計(jì)劃進(jìn)行有癥狀的頸動(dòng)脈血管成形術(shù)的患者進(jìn)行比較。為了確定該方法的有效性，將研究組的心臟手術(shù)后并發(fā)癥發(fā)生率與配對(duì)病例對(duì)照進(jìn)行了比較。
結(jié)果：22例患者接受了選擇性頸動(dòng)脈成形術(shù)治療，未出現(xiàn)持續(xù)的主要神經(jīng)系統(tǒng)并發(fā)癥;除1例患者外，所有患者均接受了手術(shù)，未出現(xiàn)持續(xù)的主要神經(jīng)系統(tǒng)疾病。兩名患者在30天內(nèi)死于心源性休克。
結(jié)論：在本研究組中，假定為中風(fēng)的高風(fēng)險(xiǎn)患者，在心臟手術(shù)前進(jìn)行選擇性頸動(dòng)脈血管成形術(shù)相對(duì)安全有效。盡管這種策略不能在這些高?；颊咧蓄A(yù)防中風(fēng)，但數(shù)據(jù)表明，這種方法將中風(fēng)的術(shù)后類(lèi)型從嚴(yán)重的血流動(dòng)力學(xué)中風(fēng)轉(zhuǎn)移到了輕度栓塞性中風(fēng)，具有良好的神經(jīng)功能。需要更大的研究來(lái)確定這種策略是否可以有效消除心臟手術(shù)后血液動(dòng)力學(xué)中風(fēng)的發(fā)生。（譯文來(lái)自GOOGLE)
safety and effectiveness of selective carotid angioplasty.pdf
