糖尿病并不是颈动脉支架置入术（carotid revascularization with stenting）预后的预测因素，而颈动脉内膜切除术（carotid endarterectomy）可能是。
Diabetes is not a predictor of outcome for carotid revascularization with stenting as it may be for carotid endarterectomy.
机构信息
Unit of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, Perugia, University of Perugia, Perugia, Italy.
出版信息
J Vasc Surg. 2012 Jan;55(1):79-89; discussion 88-9. doi: 10.1016/j.jvs.2011.07.080. Epub 2011 Nov 3.
BACKGROUND
Diabetes is prevalent in most patients undergoing carotid revascularization and is suggested as a marker of poor outcome after carotid endarterectomy (CEA). Data on outcome of diabetic patients undergoing carotid artery stenting (CAS) are limited. The aim of this study was to investigate early and 6-year outcomes of diabetic patients undergoing carotid revascularization with CAS and CEA.
METHODS
The database of patients undergoing carotid revascularization for primary carotid stenosis was queried from 2001 to 2009. Diabetic patients were defined as those with established diagnosis and/or receiving oral hypoglycemic or insulin therapy. Multivariate and Kaplan- Meier analyses, stratified by type of treatment, were performed on perioperative (30 days) and late outcomes.
RESULTS
A total of 2196 procedures, 1116 by CEA and 1080 by CAS (29% female, mean age 71.3 years), were reviewed. Diabetes was prevalent in 630 (28.7%). Diabetic patients were younger (P < .0001) and frequently had hypertension (P = .018) or coronary disease (P = .019). Perioperative stroke/death rate was 2.7% (17/630) in diabetic patients vs 2.3% (36/1566) in nondiabetic, (P = .64); the rate was 3.4% in diabetic CEA group and 2.1% in diabetic CAS group (P = .46). At multivariate analyses, diabetes was a predictor of perioperative stroke/death in the CEA group (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.05-7.61; P = .04) but not in the CAS group (P = .72). Six-year survival was 76.0% in diabetics and 80.8% in nondiabetics (P = .15). Six-year late stroke estimates were 3.2% in diabetic and 4.6% in nondiabetic patients (P = .90). The 6-year risk of restenosis was similar (4.6% % vs 4.2%) in diabetic and nondiabetic patients (P = .56). Survival, late stroke, and restenosis rates between diabetics and nondiabetics were similar in CAS and CEA groups.
CONCLUSIONS
Diabetic patients are not at greater risk of perioperative morbidity and mortality or late stroke after CAS, however, the perioperative risk can be higher after CEA. This may help in selecting the appropriate technique for carotid revascularization in patients best suited for the type of procedure.
背景
糖尿病在大多数接受颈动脉血运重建的患者中很常见，并且被认为是颈动脉内膜切除术（CEA）后预后不良的标志物。有关接受颈动脉支架置入术（CAS）的糖尿病患者的结果数据有限。本研究的目的是调查接受 CAS 和 CEA 治疗的糖尿病患者的早期和 6 年结果。
方法
从 2001 年至 2009 年查询了接受原发性颈动脉狭窄颈动脉血运重建的患者数据库。糖尿病患者被定义为有明确诊断和/或接受口服降糖药或胰岛素治疗的患者。对围手术期（30 天）和晚期结果进行了多变量和 Kaplan-Meier 分析，并按治疗类型分层。
结果
共回顾了 2196 例手术，1116 例 CEA 和 1080 例 CAS（29%为女性，平均年龄 71.3 岁）。630 例（28.7%）患有糖尿病。糖尿病患者更年轻（P<.0001），并且经常患有高血压（P=0.018）或冠心病（P=0.019）。围手术期卒中/死亡率为 2.7%（630 例中的 17 例），而非糖尿病患者为 2.3%（1566 例中的 36 例）（P=0.64）；糖尿病 CEA 组为 3.4%，糖尿病 CAS 组为 2.1%（P=0.46）。多变量分析显示，糖尿病是 CEA 组围手术期卒中/死亡的预测因素（比值比[OR]，2.83；95%置信区间[CI]，1.05-7.61；P=0.04），但不是 CAS 组（P=0.72）。糖尿病患者的 6 年生存率为 76.0%，非糖尿病患者为 80.8%（P=0.15）。糖尿病患者和非糖尿病患者的 6 年迟发性卒中估计值分别为 3.2%和 4.6%（P=0.90）。糖尿病和非糖尿病患者的 6 年再狭窄风险相似（4.6% vs 4.2%）（P=0.56）。糖尿病患者和非糖尿病患者在 CAS 和 CEA 组之间的生存率、迟发性卒中率和再狭窄率相似。
结论
糖尿病患者在 CAS 后围手术期发病率和死亡率或迟发性卒中方面的风险并不增加，但 CEA 后围手术期风险可能更高。这可能有助于为最适合手术类型的患者选择适当的颈动脉血运重建技术。
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