Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction
Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction
复制标题
慢性肾病或过敏反应患者无需使用造影剂的双重辅助颈动脉支架置入术
DOI：
10.1007/s00234-016-1678-x
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发表时间：
2016
期刊：
影响因子：
2.8
通讯作者：
Kohmura E
中科院分区：
文献类型：
--
作者：
Mizowaki T;Fujita A;Imahori T;Uyama A;Inoue S;Kohta M;Hamaguchi H;Sasayama T;Hosoda K;Kohmura E
本研究旨在探讨双辅助颈动脉支架植入术（CAS）预防不良反应的安全性和可行性。方法15例伴有慢性肾病（CKD）（期≥3）或造影剂过敏的颈动脉严重狭窄（≥70%）患者（占所有CASs患者的9%）在4年以上的时间里接受了双辅助CAS治疗，未使用造影剂。比较双辅助CAS组（n= 15）与常规CAS组（n= 153）的手术成功率及围手术期并发症发生率。结果两组手术成功率均为100%。手术后合并卒中或死亡率在双辅助CAS组（0/ 15,0 %）和常规CAS组（4/153,2.6%）之间无显著差异。双辅助CAS组14例CKD患者均未出现肾功能进一步恶化。双辅助CAS组受试者的平均表面辐射剂量（n= 13、312±131 mGy）显著低于常规CAS组（n= 31、1036±571 mGy） （p< 0.001）。双辅助CAS组（156±39.7 min）与常规CAS组（156±37.4 min）的平均持续时间无显著差异。结论对于肾毒性造影剂引起肾功能衰竭的高危患者或对造影剂过敏的患者，双辅助CAS不加造影剂可作为一种选择。
IntroductionWe aimed to investigate the safety and feasibility of duplex-assisted carotid artery stenting (CAS) without administration of contrast medium for the prevention of adverse reactions.MethodsFifteen patients (9 % of all CASs) with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast medium underwent duplex-assisted CAS without administration of contrast medium over 4 years. The procedural success rate and perioperative complication rates were compared between the duplex-assisted CAS (n= 15) and conventional CAS (n= 153) groups.ResultsThe technical success rate was 100 % in both groups. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex-assisted CAS group (0/15, 0 %) and conventional CAS group (4/153, 2.6 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. The mean surface radiation dose of participants in the duplex-assisted CAS group (n= 13, 312 ± 131 mGy) was significantly lower than that of the conventional CAS group (n= 31, 1036 ± 571 mGy) (p< 0.001). The mean duration of CAS procedure was not significantly different between the duplex-assisted CAS group (156 ± 39.7 min) and the conventional CAS group (156 ± 37.4 min).ConclusionDuplex-assisted CAS without administration of contrast medium could be an alternative option in selected patients deemed to be at high risk for renal failure from nephrotoxic contrast medium or who have an allergy to contrast medium.