Jackson Benjamin M, English Sean J, Fairman Ronald M, Karmacharya Jagajan, Carpenter Jeffrey P, Woo Edward Y
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
J Vasc Surg. 2008 Jul;48(1):74-9. doi: 10.1016/j.jvs.2008.02.005. Epub 2008 May 23.
Age greater than 80 has been identified as a risk factor for complications, including stroke and death, in patients undergoing carotid artery angioplasty and stenting (CAS). This study evaluates other potential predictors of perioperative complications in patients undergoing CAS.
All cerebrovascular endovascular procedures performed by the vascular surgery division at our university hospital between July 2003 and December 2005 were retrospectively examined. During the course of 212 admissions, 198 patients underwent 215 procedures. Patient age, comorbidities, and admission status were analyzed as independent (predictor) variables. Complication rate, discharge disposition, and length of hospital stay were considered dependent (outcome) variables. Logistic regression and Fisher exact test or Student t test were performed, as appropriate.
Complications included major and minor stroke, myocardial infarction, femoral artery pseudoaneurysm, and death. The rates of perioperative major and minor stroke were 0.5% and 2.8%, respectively. Chronic renal insufficiency was a predictor of perioperative complications, including stroke: patients with serum creatinine greater than 1.3 mg/dL had a 37% complication rate and a 11.1% stroke rate, while those with normal renal function had a 13% complication rate (P = .003) and a 0.6% stroke rate (P =.001). Similar association was seen between creatinine clearance and both stroke and complications. Obesity was a risk factor for complications, but not stroke: obese patients had a complication rate of 28%, while others had a 16% complication rate (P = .024). Emergency admission predicted both extended hospital stay (P < .001) and requirement for further inpatient care in a rehabilitation or nursing facility (P = .007). There was no significant difference in complication rate or stroke rate between octogenarians and others.
This experience demonstrates that chronic renal insufficiency, obesity, and emergent clinical setting are risk factors for patients undergoing CAS.
年龄大于80岁已被确定为接受颈动脉血管成形术和支架置入术（CAS）的患者发生并发症（包括中风和死亡）的危险因素。本研究评估了接受CAS治疗的患者围手术期并发症的其他潜在预测因素。
对我校医院血管外科在2003年7月至2005年12月期间进行的所有脑血管腔内手术进行回顾性检查。在212例入院病例中，198例患者接受了215次手术。将患者年龄、合并症和入院状态作为独立（预测）变量进行分析。并发症发生率、出院处置情况和住院时间被视为相关（结果）变量。酌情进行逻辑回归分析以及Fisher精确检验或Student t检验。
并发症包括严重和轻微中风、心肌梗死、股动脉假性动脉瘤和死亡。围手术期严重和轻微中风的发生率分别为0.5%和2.8%。慢性肾功能不全是围手术期并发症（包括中风）的一个预测因素：血清肌酐大于1.3mg/dL的患者并发症发生率为37%，中风发生率为11.1%，而肾功能正常的患者并发症发生率为13%（P = 0.003），中风发生率为0.6%（P = 0.001）。肌酐清除率与中风和并发症之间也存在类似关联。肥胖是并发症的危险因素，但不是中风的危险因素：肥胖患者的并发症发生率为28%，而其他患者为16%（P = 0.024）。急诊入院预示着住院时间延长（P < 0.001）以及需要在康复或护理机构接受进一步的住院治疗（P = 0.007）。八旬老人与其他患者之间的并发症发生率或中风发生率没有显著差异。
该经验表明，慢性肾功能不全、肥胖和紧急临床情况是接受CAS治疗患者的危险因素。
