Vogel Todd R, Dombrovskiy Viktor Y, Haser Paul B, Scheirer James C, Graham Alan M
Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School, The Surgical Outcomes Research Group, New Brunswick, NJ 08903-0019, USA.
J Vasc Surg. 2009 Feb;49(2):325-30; discussion 330. doi: 10.1016/j.jvs.2008.08.112. Epub 2008 Dec 5.
With the evolution of endovascular techniques, carotid artery stenting (CAS) has been compared to carotid endarterectomy (CEA). Several studies have reported inferior results with CAS in the elderly. The objective of this study was to evaluate national outcomes of CAS and CEA and to compare utilization and outcomes of these procedures in different age groups.
We evaluated the 2005 Nationwide Inpatient Sample for hospitalizations with a procedure of CAS or CEA within 2 days after admission at age 60 years and above. Procedures were analyzed with respect to patient demographics and associated complications.
A total of 80,498 carotid interventions (73,929 CEA and 6,569 CAS) were identified. The overall incidence of stroke was 4.16% after CAS and 2.66% after CEA (P < .0001). CAS was more often utilized in octogenarians than in younger patients (8.55% in 80+ vs 7.92% in 60-69 years; P < .0002). Increased age was not associated with greater stroke rates after CAS or CEA (P = .19 and .06, respectively). Octogenarians, compared to younger patients, had greater cardiac, pulmonary, and renal complications after CEA (3.0% vs 1.9%, 1.9% vs 1.0%, and 1.4% vs 0.54%, respectively; P < .0001). When adjusted by age, gender, complications, and Elixhauser comorbidities, patients after CAS were 1.6 times as likely to have a stroke (confidence interval [CI] = 1.37-1.78) when compared to CEA. Significant predictors of postoperative hospital mortality were stroke (odds ratio [OR] = 29.0; 95% CI = 21.5-39.1), cardiac complications (OR = 6.4; 95% CI = 4.4-9.1), pulmonary complications (OR = 3.5; 95% CI = 2.31-5.19), and renal failure (OR = 2.5; 95% CI = 1.6-3.8). With increasing age, overall mortality steadily increased after CAS (from 0.23% to 0.67%; P = .0409) but remained stable after CEA.
Octogenarians did not have a higher risk of stroke after CAS when compared to younger patients. Stroke was the strongest predictor of hospital mortality. The increased utilization of CAS in the aged, which had significantly higher stroke rates in all age groups studied, may account for the greater hospital mortality seen after CAS in the elderly. Further studies focused on the aged are needed to define the best management strategies in the elderly.
随着血管内技术的发展，已将颈动脉支架置入术（CAS）与颈动脉内膜切除术（CEA）进行了比较。多项研究报告称，老年患者接受CAS的结果较差。本研究的目的是评估CAS和CEA的全国性结果，并比较不同年龄组中这些手术的应用情况和结果。
我们评估了2005年全国住院患者样本中60岁及以上患者入院后2天内接受CAS或CEA手术的住院情况。根据患者人口统计学和相关并发症对手术进行了分析。
共确定了80498例颈动脉干预手术（73929例CEA和6569例CAS）。CAS术后中风的总体发生率为4.16%，CEA术后为2.66%（P <.0001）。与年轻患者相比，八旬老人更常接受CAS（80岁及以上患者为8.55%，60 - 69岁患者为7.92%；P <.0002）。年龄增加与CAS或CEA术后更高的中风发生率无关（分别为P =.19和.06）。与年轻患者相比，八旬老人CEA术后心脏、肺部和肾脏并发症更多（分别为3.0%对1.9%、1.9%对1.0%、1.4%对0.54%；P <.0001）。在根据年龄、性别、并发症和埃利克斯豪泽共病进行调整后，与CEA相比，CAS术后患者发生中风的可能性高1.6倍（置信区间[CI] = 1.37 - 1.78）。术后医院死亡率的显著预测因素为中风（比值比[OR] = 29.0；95% CI = 21.5 - 39.1）、心脏并发症（OR = 6.4；95% CI = 4.4 - 9.1）、肺部并发症（OR = 3.5；95% CI = 2.31 - 5.19）和肾衰竭（OR = 2.5；95% CI = 1.6 - 3.8）。随着年龄的增加，CAS术后总体死亡率稳步上升（从0.23%升至0.67%；P =.0409），但CEA术后保持稳定。
与年轻患者相比，八旬老人接受CAS后中风风险并未更高。中风是医院死亡率的最强预测因素。在所有研究的年龄组中，CAS在老年人中的应用增加且中风发生率显著更高，这可能是老年人CAS术后医院死亡率更高的原因。需要针对老年人开展进一步研究以确定最佳管理策略。
