Kumar Prasanna Venkatesh, Lakshmi Aishwarya, Shrivastava Rakesh, Mundi Aman, Tandon Anshu, Desouza Kavit A, Caldito Gloria, Jimenez Enrique, Khan Bobby V, Tandon Neeraj
Overton Brooks VA Medical Center and Louisiana State University Health Sciences Center, Shreveport, LA, USA.
South Med J. 2011 Apr;104(4):257-63. doi: 10.1097/SMJ.0b013e31820d8e39.
To compare the 30-day, six-month, and one-year outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in male veterans, and to identify any predictors of adverse outcomes. CAS has been shown to be non-inferior to CEA in patients at high-risk for CEA. The outcome of CAS compared to low-risk CEA is less clear.
Retrospective analysis of 96 consecutive patients who underwent CAS (N = 31) or CEA (N = 65). The cumulative 30-day, six-month, and one-year incidence of ipsilateral transient ischemic attack (TIA) or stroke, restenosis or reocclusion, need for target vessel revascularization, non-fatal myocardial infarction (MI), and death were compared.
All patients in the CAS group were at high risk for CEA. Among the CEA group, 50 (76.9%) were at high risk and the remaining 15 (23.1%) were considered to be at low risk. The cumulative incidence of adverse outcomes with CAS and CEA, respectively, at 30 days (3.2% vs 9.2%, P = ns), six months (3.2 vs 18.5%, P = 0.047), and one year (9.7% vs 18.5%, P = ns) favored CAS. This difference was primarily due to adverse events in the high-risk CEA patients. There was no significant difference in outcome between the CAS and low-risk CEA groups. The independent significant predictors for adverse outcomes within six months were the group (P = 0.047) and number of risk factors (P = 0.01). Interestingly, the use of angiotensin-converting enzyme inhibitors (ACE-I) predicted adverse outcomes within one year (P = 0.01).
CAS may be superior to high-risk CEA with better six-month outcomes. The outcomes with CAS were not significantly different compared to low-risk CEA, suggesting that CAS may be non-inferior to low-risk CEA.
比较男性退伍军人接受颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）后的30天、6个月和1年的结局，并确定不良结局的任何预测因素。在CEA高风险患者中，CAS已被证明不劣于CEA。与低风险CEA相比，CAS的结局尚不清楚。
对96例连续接受CAS（n = 31）或CEA（n = 65）的患者进行回顾性分析。比较同侧短暂性脑缺血发作（TIA）或中风、再狭窄或再闭塞、靶血管血运重建需求、非致命性心肌梗死（MI）和死亡的累积30天、6个月和1年发生率。
CAS组所有患者均为CEA高风险患者。在CEA组中，50例（76.9%）为高风险，其余15例（23.1%）被认为是低风险。CAS和CEA在30天（3.2%对9.2%，P = 无统计学意义）、6个月（3.2对18.5%，P = 0.047）和1年（9.7%对18.5%，P = 无统计学意义）时不良结局的累积发生率有利于CAS。这种差异主要是由于高风险CEA患者的不良事件。CAS组和低风险CEA组之间的结局无显著差异。6个月内不良结局的独立显著预测因素是分组（P = 0.047）和风险因素数量（P = 0.01）。有趣的是，使用血管紧张素转换酶抑制剂（ACE-I）可预测1年内的不良结局（P = 0.01）。
CAS可能优于高风险CEA，6个月结局更好。与低风险CEA相比，CAS的结局无显著差异，表明CAS可能不劣于低风险CEA。
