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：降低心脏手术后的中风发生率仍然具有挑战性，尤其是对于闭塞性脑血管疾病的患者。尚无所有高级别颈动脉狭窄患者的血管成形术能有效降低术后卒中发生率。在这项研究中，我们仅针对颅内侧支较差的住院患者，介绍了使用选择性颈动脉血管成形术的另一种方法的初步结果。
方法：我们进行了单中心研究，以评估该程序的安全性。将研究组的血管成形术后并发症发生率与计划进行有症状的颈动脉血管成形术的患者进行比较。为了确定该方法的有效性，将研究组的心脏手术后并发症发生率与配对病例对照进行了比较。
结果：22例患者接受了选择性颈动脉成形术治疗，未出现持续的主要神经系统并发症;除1例患者外，所有患者均接受了手术，未出现持续的主要神经系统疾病。两名患者在30天内死于心源性休克。
结论：在本研究组中，假定为中风的高风险患者，在心脏手术前进行选择性颈动脉血管成形术相对安全有效。尽管这种策略不能在这些高危患者中预防中风，但数据表明，这种方法将中风的术后类型从严重的血流动力学中风转移到了轻度栓塞性中风，具有良好的神经功能。需要更大的研究来确定这种策略是否可以有效消除心脏手术后血液动力学中风的发生。（译文来自GOOGLE)

safety and effectiveness of selective carotid angioplasty.pdf