{"title":"颈动脉支架植入术治疗维持性血液透析患者颈动脉狭窄的临床效果。","authors":"Shuki Okuhara, Tomoaki Murakami, Shingo Toyota, Kosei Okochi, Koichi Nakashima, Kazuhiro Tohara, Shuhei Yamada, Takamune Achiha, Maki Kobayashi, Haruhiko Kishima","doi":"10.2176/jns-nmc.2024-0193","DOIUrl":null,"url":null,"abstract":"<p><p>Most previous large studies of carotid artery stenting (CAS) in maintenance hemodialysis patients are old-era, do not describe the types of stents and method of protection, and their effectiveness is unknown. CAS has progressed remarkably, and tailor-made CAS is now possible in hemodialysis patients according to the lesion. We aimed to analyze the outcomes of CAS in maintenance hemodialysis patients treated in our institution.We retrospectively investigated the data of patients who underwent elective CAS in our institution between January 2012 and April 2023. Firstly, we verified the outcomes of CAS in maintenance hemodialysis patients. Secondly, the outcomes of CAS in maintenance hemodialysis patients were compared with CAS in nondialysis patients during the same period.During the study period, 212 patients with carotid stenosis underwent CAS. Among these, 18 patients undergoing maintenance hemodialysis were identified for analysis. All 18 patients underwent lesion-specific tailor-made CAS. All 18 patients were technically successfully stented with good vasodilation and improvement in stenosis. No symptomatic cerebral infarction occurred within 30 days after CAS. There was no difference between dialysis and nondialysis patients in the risk of symptomatic complications and death occurring within 30 days after surgery. There was a higher risk of hemorrhagic complications not associated with prognosis in the dialysis group (23.1% vs 1.0%, P = 0.0047). No in-stent restenosis (>50% stenosis) and ipsilateral cerebral infarction at 1 year occurred during follow-up.CAS in hemodialysis patients may be safe and effective.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical Outcomes of Carotid Artery Stenting for Carotid Artery Stenosis in Maintenance Hemodialysis Patients.\",\"authors\":\"Shuki Okuhara, Tomoaki Murakami, Shingo Toyota, Kosei Okochi, Koichi Nakashima, Kazuhiro Tohara, Shuhei Yamada, Takamune Achiha, Maki Kobayashi, Haruhiko Kishima\",\"doi\":\"10.2176/jns-nmc.2024-0193\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Most previous large studies of carotid artery stenting (CAS) in maintenance hemodialysis patients are old-era, do not describe the types of stents and method of protection, and their effectiveness is unknown. CAS has progressed remarkably, and tailor-made CAS is now possible in hemodialysis patients according to the lesion. We aimed to analyze the outcomes of CAS in maintenance hemodialysis patients treated in our institution.We retrospectively investigated the data of patients who underwent elective CAS in our institution between January 2012 and April 2023. Firstly, we verified the outcomes of CAS in maintenance hemodialysis patients. Secondly, the outcomes of CAS in maintenance hemodialysis patients were compared with CAS in nondialysis patients during the same period.During the study period, 212 patients with carotid stenosis underwent CAS. Among these, 18 patients undergoing maintenance hemodialysis were identified for analysis. All 18 patients underwent lesion-specific tailor-made CAS. All 18 patients were technically successfully stented with good vasodilation and improvement in stenosis. No symptomatic cerebral infarction occurred within 30 days after CAS. There was no difference between dialysis and nondialysis patients in the risk of symptomatic complications and death occurring within 30 days after surgery. There was a higher risk of hemorrhagic complications not associated with prognosis in the dialysis group (23.1% vs 1.0%, P = 0.0047). No in-stent restenosis (>50% stenosis) and ipsilateral cerebral infarction at 1 year occurred during follow-up.CAS in hemodialysis patients may be safe and effective.</p>\",\"PeriodicalId\":19225,\"journal\":{\"name\":\"Neurologia medico-chirurgica\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-11-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurologia medico-chirurgica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2176/jns-nmc.2024-0193\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurologia medico-chirurgica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2176/jns-nmc.2024-0193","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
以往对维持性血液透析患者进行颈动脉支架置入术(CAS)的大型研究大多年代久远,未对支架类型和保护方法进行描述,其效果也不得而知。目前,CAS 已取得显著进展,可根据病变情况为血液透析患者量身定制 CAS。我们回顾性调查了 2012 年 1 月至 2023 年 4 月期间在我院接受选择性 CAS 治疗的患者数据。首先,我们核实了维持性血液透析患者接受 CAS 治疗的结果。在研究期间,212 名颈动脉狭窄患者接受了 CAS。在研究期间,212 名颈动脉狭窄患者接受了 CAS 手术,其中 18 名接受维持性血液透析的患者被确定为分析对象。所有 18 名患者都接受了针对病变部位量身定制的 CAS。所有 18 名患者都成功地进行了技术性支架置入,血管扩张良好,狭窄情况有所改善。CAS 术后 30 天内未发生无症状脑梗塞。透析患者和非透析患者在术后30天内出现症状性并发症和死亡的风险没有差异。透析组发生与预后无关的出血性并发症的风险较高(23.1% vs 1.0%,P = 0.0047)。随访期间没有发生支架内再狭窄(狭窄程度大于50%)和同侧脑梗死。
Clinical Outcomes of Carotid Artery Stenting for Carotid Artery Stenosis in Maintenance Hemodialysis Patients.
Most previous large studies of carotid artery stenting (CAS) in maintenance hemodialysis patients are old-era, do not describe the types of stents and method of protection, and their effectiveness is unknown. CAS has progressed remarkably, and tailor-made CAS is now possible in hemodialysis patients according to the lesion. We aimed to analyze the outcomes of CAS in maintenance hemodialysis patients treated in our institution.We retrospectively investigated the data of patients who underwent elective CAS in our institution between January 2012 and April 2023. Firstly, we verified the outcomes of CAS in maintenance hemodialysis patients. Secondly, the outcomes of CAS in maintenance hemodialysis patients were compared with CAS in nondialysis patients during the same period.During the study period, 212 patients with carotid stenosis underwent CAS. Among these, 18 patients undergoing maintenance hemodialysis were identified for analysis. All 18 patients underwent lesion-specific tailor-made CAS. All 18 patients were technically successfully stented with good vasodilation and improvement in stenosis. No symptomatic cerebral infarction occurred within 30 days after CAS. There was no difference between dialysis and nondialysis patients in the risk of symptomatic complications and death occurring within 30 days after surgery. There was a higher risk of hemorrhagic complications not associated with prognosis in the dialysis group (23.1% vs 1.0%, P = 0.0047). No in-stent restenosis (>50% stenosis) and ipsilateral cerebral infarction at 1 year occurred during follow-up.CAS in hemodialysis patients may be safe and effective.