Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, PO Box 85500, G03.228, 3508 GA Utrecht, the Netherlands.
Stroke. 2011 Dec;42(12):3491-6. doi: 10.1161/STROKEAHA.111.624478. Epub 2011 Oct 13.
Arterial hypotension is more frequently observed early after carotid artery stenting (CAS) than after carotid endarterectomy (CEA), but their long-term effects on blood pressure (BP) are unclear. We compared the effects of CAS and CEA on BP up to 1 year after treatment in the International Carotid Stenting Study.
Patients with symptomatic carotid stenosis were randomly allocated to CAS or CEA. Systolic and diastolic BP were recorded at baseline, at discharge, and at 1, 6, and 12 months. Antihypertensive medication use was recorded. A per-protocol analysis was performed. Patients with missing BP records were excluded. Between-group BP changes were compared and adjusted for baseline covariates with linear regression. Within-group BP changes were compared with the paired t test.
CAS (N=587) and CEA (N=637) were both associated with a decrease in BP at discharge, which was greater after CAS (mean difference in systolic BP between groups, 10.3 mm Hg; 95% CI, 7.3-13.3; P<0.0001; in diastolic BP, 4.1 mm Hg; 95% CI, 2.4-5.7; P<0.0001). During follow-up, BP changes were not different between groups. Adjustment for differences in baseline characteristics did not change the results. Fewer patients undergoing CAS used antihypertensive medication during follow-up than patients undergoing CEA (relative risk at 12 months, 0.91; 95% CI, 0.85-0.97; P=0.0073).
CAS leads to a larger early decrease in BP than CEA, but this effect does not persist over time. CAS may lessen the requirement for antihypertensive medication more than CEA. Clinical Trial Registration- URL: www.controlled-trials.com. Unique identifier: ISRCTN25337470.
颈动脉支架置入术（CAS）后早期比颈动脉内膜切除术（CEA）更常出现动脉低血压，但它们对血压（BP）的长期影响尚不清楚。我们比较了国际颈动脉支架置入研究中治疗后 1 年内 CAS 和 CEA 对 BP 的影响。
有症状颈动脉狭窄的患者被随机分配至 CAS 或 CEA 组。在基线、出院时以及治疗后 1、6 和 12 个月记录收缩压和舒张压。记录抗高血压药物的使用情况。采用方案分析，排除 BP 记录缺失的患者。采用线性回归比较组间 BP 变化，并根据基线协变量进行调整。采用配对 t 检验比较组内 BP 变化。
CAS（N=587）和 CEA（N=637）均与出院时 BP 下降相关，CAS 下降幅度更大（组间收缩压差异，10.3mmHg；95%CI，7.3-13.3；P<0.0001；舒张压差异，4.1mmHg；95%CI，2.4-5.7；P<0.0001）。在随访期间，组间 BP 变化无差异。调整基线特征差异后，结果未改变。在随访期间，接受 CAS 的患者使用抗高血压药物的患者少于接受 CEA 的患者（12 个月时的相对风险，0.91；95%CI，0.85-0.97；P=0.0073）。
CAS 导致的早期 BP 下降幅度大于 CEA，但这种影响不会持续存在。与 CEA 相比，CAS 可能会减少对降压药物的需求。临床试验注册-网址：www.controlled-trials.com。唯一识别码：ISRCTN25337470。
