Hill B B, Olcott C, Dalman R L, Harris E J, Zarins C K
Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA, USA.
J Vasc Surg. 1999 Jul;30(1):26-35. doi: 10.1016/s0741-5214(99)70173-4.
Patients with recurrent carotid artery stenosis are sometimes referred for carotid angioplasty and stenting because of reports that carotid reoperation has a higher complication rate than primary carotid endarterectomy. The purpose of this study was to determine whether a difference exists between outcomes of primary carotid endarterectomy and reoperative carotid surgery.
Medical records were reviewed for all carotid operations performed from September 1993 through March 1998 by vascular surgery faculty at a single academic center. The results of primary carotid endarterectomy and operation for recurrent carotid stenosis were compared.
A total of 390 operations were performed on 352 patients. Indications for primary carotid endarterectomy (n = 350) were asymptomatic high-grade stenosis in 42% of the cases, amaurosis fugax and transient ischemic symptoms in 35%, global symptoms in 14%, and previous stroke in 9%. Indications for reoperative carotid surgery (n = 40) were symptomatic recurrent lesions in 50% of the cases and progressive high-grade asymptomatic stenoses in 50%. The results of primary carotid endarterectomy were no postoperative deaths, an overall stroke rate of 1.1% (three postoperative strokes, one preoperative stroke after angiography), and no permanent cranial nerve deficits. The results of operations for recurrent carotid stenosis were no postoperative deaths, no postoperative strokes, and no permanent cranial nerve deficits. In the primary carotid endarterectomy group, the mean hospital length of stay was 2.6 +/- 1. 1 days and the mean hospital cost was $9700. In the reoperative group, the mean length of stay was 2.6 +/- 1.5 days and the mean cost was $13,700. The higher cost of redo surgery is accounted for by a higher preoperative cerebral angiography rate (90%) in redo cases as compared with primary endarterectomy (40%).
In this series of 390 carotid operations, the procedure-related stroke/death rate was 0.8%. There were no differences between the stroke-death rates after primary carotid endarterectomy and operation for recurrent carotid stenosis. Operation for recurrent carotid stenosis is as safe and effective as primary carotid endarterectomy and should continue to be standard treatment.
复发性颈动脉狭窄患者有时会因有报道称颈动脉再次手术的并发症发生率高于初次颈动脉内膜切除术而被推荐接受颈动脉血管成形术和支架置入术。本研究的目的是确定初次颈动脉内膜切除术和再次颈动脉手术的结果之间是否存在差异。
回顾了1993年9月至1998年3月期间在一个学术中心由血管外科医生进行的所有颈动脉手术的病历。比较了初次颈动脉内膜切除术和复发性颈动脉狭窄手术的结果。
共对352例患者进行了390次手术。初次颈动脉内膜切除术（n = 350）的指征为：42%的病例为无症状性重度狭窄，35%为一过性黑矇和短暂性缺血症状，14%为全身性症状，9%为既往有卒中史。再次颈动脉手术（n = 40）的指征为：50%的病例为有症状的复发性病变，50%为进行性重度无症状性狭窄。初次颈动脉内膜切除术的结果为无术后死亡，总体卒中发生率为1.1%（3例术后卒中，1例血管造影术后术前卒中），无永久性脑神经缺损。复发性颈动脉狭窄手术的结果为无术后死亡，无术后卒中，无永久性脑神经缺损。在初次颈动脉内膜切除术组，平均住院时间为2.6±1.1天，平均住院费用为9700美元。在再次手术组，平均住院时间为2.6±1.5天，平均费用为13700美元。再次手术费用较高的原因是与初次内膜切除术（40%）相比，再次手术病例术前脑血管造影率较高（90%）。
在这一系列390例颈动脉手术中，与手术相关的卒中/死亡率为0.8%。初次颈动脉内膜切除术和复发性颈动脉狭窄手术的卒中死亡率之间无差异。复发性颈动脉狭窄手术与初次颈动脉内膜切除术一样安全有效，应继续作为标准治疗方法。
