Darling R Clement, Mehta Manish, Roddy Sean P, Paty Philip S K, Kreienberg Paul B, Ozsvath Kathleen J, Chang Benjamin B, Shah Dhiraj M
Institute for Vascular Health and Disease, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
Cardiovasc Surg. 2003 Oct;11(5):347-52. doi: 10.1016/S0967-2109(03)00076-0.
Recurrent carotid stenosis following standard longitudinal carotid endarterectomy (s- CEA), with and without patch angioplasty, effects the durability of the procedure and can lead to reintervention. The purpose of this study is to evaluate the incidence of restenosis following eversion carotid endarterectomy (e-CEA) in women.
The records of all patients undergoing elective carotid endarterectomy (CEA) for symptomatic and asymptomatic high-grade carotid stenosis over a 5-year period from July 1994 to June 1999 were reviewed. Eversion endarterectomy was performed preferentially under regional anesthesia in awake patients. Postoperatively, patients were routinely evaluated by duplex scans at 3 months, 6 months, 12 months, and yearly thereafter. Hemodynamically significant restenosis (>70%) via duplex scans was confirmed by standard or magnetic resonance angiography. Student's t-test and Chi square analysis were used to assess statistical significance and assumed for P<0.05.
Over this 5-year period, 3429 eversion carotid endarterectomies were done for symptomatic (female: 375, male: 573) and asymptomatic (female: 1091, male: 1390) high grade carotid stenosis. In the postoperative period 18 (0.9%) male and 12 (0.8%) female patients developed a permanent stroke (P = NS). Operative mortality was 0.6% (n = 12) in males and 0.5% (n = 8) in females (P = NS). Cranial nerve injuries, wound infections, and neck hematoma occurred in 7 (0.4%), 2 (0.1%), and 26 (1.3%) male and in 3 (0.2%), 3 (0.2%), and 15 (1.0%) female patients, respectively. Recurrent carotid stenosis greater than 70% via duplex scan (PSV >125 cm/s and EDV >100 cm/s) developed in 12 (1.0%) males and 15 (1.5%) females (P = NS).
The eversion technique for CEA requires both the transection and anastomosis of the internal carotid artery at the carotid bulb, and appears to result in a low incidence of restenosis in women. This is a straightforward technique and obviates the need for primary closure of distal smaller caliber internal carotid artery that can lead to narrowing, and the use of patch closure that has its attendant risks.
标准纵向颈动脉内膜切除术（s-CEA）后复发性颈动脉狭窄，无论有无补片血管成形术，都会影响手术的耐久性并可能导致再次干预。本研究的目的是评估外翻式颈动脉内膜切除术（e-CEA）在女性患者中再狭窄的发生率。
回顾了1994年7月至1999年6月这5年间所有因有症状和无症状的重度颈动脉狭窄而接受择期颈动脉内膜切除术（CEA）的患者记录。外翻式内膜切除术优先在清醒患者的区域麻醉下进行。术后，患者在3个月、6个月、12个月时常规接受双功超声扫描评估，此后每年评估一次。通过双功超声扫描发现的血流动力学意义上的显著再狭窄（>70%）通过标准或磁共振血管造影进行确认。采用学生t检验和卡方分析来评估统计学意义，P<0.05为有统计学意义。
在这5年期间，共对有症状（女性：375例，男性：573例）和无症状（女性：1091例，男性：1390例）的重度颈动脉狭窄患者进行了3429例外翻式颈动脉内膜切除术。术后，18例（0.9%）男性和1例（0.8%）女性患者发生永久性卒中（P=无统计学意义）。男性手术死亡率为0.6%（n=12），女性为0.5%（n=8）（P=无统计学意义）。男性和女性患者中分别有7例（0.4%）、2例（0.1%）、26例（1.3%）和3例（0.2%）、3例（0.2%）、15例（1.0%）发生颅神经损伤、伤口感染和颈部血肿。通过双功超声扫描发现复发性颈动脉狭窄大于70%（PSV>125 cm/s且EDV>100 cm/s）的男性有例（1.0%），女性有15例（1.5%）（P=无统计学意义）。
CEA的外翻技术需要在颈动脉球部横断并吻合颈内动脉，在女性中似乎导致再狭窄的发生率较低。这是一种简单直接的技术，避免了对可能导致狭窄的远端较小口径颈内动脉进行一期缝合的需要，以及使用有相关风险的补片缝合的需要。
