Clinical Efficacy Of Staged Carotid Stenting For Severe Bilateral Carotid Artery Stenosis

Objective: To retrospectively analyze the preoperative,intraoperative and postoperative follow-up data of 23 patients with severe bilateral carotid artery stenosis treated by staged carotid artery stenting(CAS),so as to explore the safety and clinical efficacy of staged stenting in the treatment of severe bilateral carotid artery stenosis.Methods: From March 2013 to January 2018,23 patients with symptomatic severe bilateral carotid artery stenosis were enrolled in the Neurointerventional Department of the Second Hospital of Hebei Medical University,who underwent the treatment of staged CAS.The technical success rate,the improvement of stenosis and clinical symptoms,intraoperative and perioperative complications,the incidence of adverse events in short and medium term,in-stent restenosis and operation interval were analyzed.Results: Among 23 patients,47 stents were implanted in 46 operations.The success rate of stent placement was 100%,and the stenosis rate of 46 vessels decreased from 86.96±7.49% to 8.26±5.89%.The NIHSS and m RS scores were 1.39±2.08 and 1.30±0.64 respectively before procedure,and were significantly improved to 0.91±1.35 and 0.52±0.67 respectively 90 days after procedure.The incidence of perioperative complications was 8.7% for decline of blood pressure and heart rate,8.7% for hyperperfusion syndrome and 4.3% for ischemic attack,respectively.The follow-up time was 90 days to 5 years,the average follow-up time was 25.43±18.30 months,of which 15 cases were followed up to more than 1 years,and 2 cases were followed up to 90 days.In the short term(90 days),the incidence of adverse clinical events was 4.3%.In the middle stage(1 year),there were no adverse clinical events or in-stent restenosis,and the stenting procedure interval was 3.81±1.25 days.Conclusion: By analyzing the success rate of operation,the improvement of vascular stenosis,the perioperative complications,the incidence of adverse clinical events and the short and mid-term clinical efficacy,it is found that staged CAS is safe and effective for patients with severe bilateral carotid artery stenosis.The individualized procedure strategy and appropriate perioperative management can achieve good curative effect and shorten the interval of operation.