Department of Neurology and Stroke Program, Wayne State University, Detroit, MI 48201, USA.
Stroke. 2010 Apr;41(4):757-64. doi: 10.1161/STROKEAHA.109.569426. Epub 2010 Feb 25.
Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) is an ongoing prospective, nonrandomized, multicenter clinical trial enrolling patients undergoing carotid artery stenting. The aim of this analysis is to identify risk predictors for periprocedural stroke in patients > or = 80 years old.
Symptomatic patients with > or = 50% stenosis and asymptomatic patients with > or = 80% stenosis were enrolled. Patients' neurological status was assessed by an independent neurologist before as well as 24 hours and 30 days postprocedure. All strokes and suspected strokes were adjudicated by an independent committee. Logistic regression analysis was conducted to identify baseline demographic, lesion, procedural, or comorbidity parameters associated with outcomes in patients > or = 80 years of age.
As of January 10, 2009, 5297 patients underwent carotid artery stenting in 186 US CAPTURE 2 clinical centers and 1166 were > or = 80 years old. Octogenarians were similar to nonoctogenarians in terms of gender and symptomatic status but had fewer of certain risk factors (prior myocardial infarction or carotid endarterectomy, diabetes, smoking history) and more cardiac arrhythmia and renal insufficiency. For the overall cohort, death/stroke rate was 3.3%; stroke rate was 2.7% (0.8% major, 1.9% minor). Death/stroke rates were significantly higher for octogenarians than nonoctogenarians (4.5% versus 3.0%) as were stroke rates (3.8% versus 2.4%). Symptomatic status, embolic protection device dwell time, and lesion length were risk predictors for periprocedural stroke in octogenarians.
Patients > or = 80 years old have higher periprocedural event rates than nonoctogenarians. Age, symptomatic status, and lesion length should be considered when identifying appropriate candidates for the procedure.
颈动脉 ACCULINK/ACCUNET 上市后试验以发现罕见事件（CAPTURE 2）是一项正在进行的前瞻性、非随机、多中心临床试验，招募接受颈动脉支架置入术的患者。本分析的目的是确定 > 或 = 80 岁患者围手术期卒中的风险预测因素。
或 = 50%狭窄的有症状患者和 > 或 = 80%狭窄的无症状患者均被纳入。患者的神经状态由独立神经科医生在术前、术后 24 小时和 30 天进行评估。所有卒中及疑似卒中均由独立委员会进行裁决。采用 logistic 回归分析确定与 > 或 = 80 岁患者结局相关的基线人口统计学、病变、手术或合并症参数。
截至 2009 年 1 月 10 日，186 个美国 CAPTURE 2 临床中心共对 5297 例患者进行了颈动脉支架置入术，其中 1166 例患者 > 或 = 80 岁。80 岁以上患者在性别和症状状态方面与非 80 岁以上患者相似，但某些危险因素（既往心肌梗死或颈动脉内膜切除术、糖尿病、吸烟史）较少，心律失常和肾功能不全较多。对于整个队列，死亡/卒中发生率为 3.3%；卒中发生率为 2.7%（0.8%为主要卒中，1.9%为次要卒中）。80 岁以上患者的死亡/卒中发生率明显高于非 80 岁以上患者（4.5%比 3.0%），卒中发生率也明显较高（3.8%比 2.4%）。症状状态、栓塞保护装置留置时间和病变长度是 80 岁以上患者围手术期卒中的风险预测因素。
或 = 80 岁患者围手术期事件发生率高于非 80 岁患者。在确定适合该手术的合适患者时，应考虑年龄、症状状态和病变长度。
