Radak Djordje, Tanasković Slobodan, Matić Predrag, Babić Srdjan, Aleksić Nikola, Ilijevski Nenad
Cardiovascular Institute Dedinje, Department of Vascular Surgery, School of Medicine, University of Belgrade, Belgrade, Republic of Serbia.
Ann Vasc Surg. 2012 Oct;26(7):924-8. doi: 10.1016/j.avsg.2011.09.011. Epub 2012 Apr 10.
The aim of this article is to review our experience in surgical treatment of carotid atherosclerosis using eversion carotid endarterectomy (eCEA) in 9,897 patients performed in the last 20 years, with particular attention to diagnostic approach, surgical technique, medical therapy, and final outcome.
From January 1991 to December 2010, 9,897 primary eCEAs were performed for high-grade carotid stenosis. Patients treated for restenosis after previous carotid surgery were excluded from the analysis. Follow-up included routine clinical evaluation and noninvasive surveillance, with duplex scanning, 1 and 6 months after surgery, and annually afterward.
The majority of the patients were symptomatic (stroke, 42.8%; transient ischemic attack, 55.1% [focal cerebral and retinal ischemia]), whereas only 2.1% of the patients were asymptomatic. For the final diagnosis, duplex scanning was performed in 83.4% of patients and angiography in only 16.3% (P < 0.001). Average carotid artery clamping time was 11.9 ± 3.2 minutes, and the majority of the patients were operated under general anesthesia (99.4%). Intraoperative shunting and local anesthesia were rarely performed; 0.6% of the patients were operated under local anesthesia, and in 0.5% of the patients, intraluminal shunt was used. Neurological and total morbidity showed a steady decline over time, with rate of neurological morbidity of 1.1% and total morbidity of 3.9% at the end of 2010. Neurological mortality and total mortality also showed a steady decline over time, with rate of neurological mortality of 0.3% and total mortality of 0.8% at the end of 2010. There was a low rate of both, nonsignificant restenosis (<50%), which was verified in 2.1% of the patients, and significant restenosis (>50%), which was observed in 4.3% of the patients.
Our data show that eCEA is a reliable surgical technique for the treatment of atherosclerotic carotid disease, with low morbidity and mortality. The specificity of our experience is the significant number of patients with preoperative stroke, but despite this fact, results are comparable with previously published series. It also highlights the importance of comprehensive surgical training in reducing complications.
本文旨在回顾我们在过去20年中对9897例患者采用外翻式颈动脉内膜切除术（eCEA）治疗颈动脉粥样硬化的经验，特别关注诊断方法、手术技术、药物治疗及最终结果。
1991年1月至2010年12月，对9897例因重度颈动脉狭窄行初次eCEA手术的患者进行研究。既往颈动脉手术后再狭窄患者排除在分析之外。随访包括术后1个月和6个月以及之后每年的常规临床评估和无创监测，采用双功超声扫描。
大多数患者有症状（中风，42.8%；短暂性脑缺血发作，55.1%[局灶性脑和视网膜缺血]），而仅有2.1%的患者无症状。最终诊断时，83.4%的患者行双功超声扫描，仅16.3%的患者行血管造影（P<0.001）。平均颈动脉阻断时间为11.9±3.2分钟，大多数患者在全身麻醉下手术（99.4%）。术中很少使用分流和局部麻醉；0.6%的患者在局部麻醉下手术，0.5%的患者使用腔内分流。神经和总并发症发生率随时间稳步下降，2010年底神经并发症发生率为1.1%，总并发症发生率为3.9%。神经死亡率和总死亡率也随时间稳步下降，2010年底神经死亡率为0.3%，总死亡率为0.8%。非显著性再狭窄（<50%）发生率较低，在2.1%的患者中得到证实，显著性再狭窄（>50%）在4.3%的患者中观察到。
我们的数据表明，eCEA是治疗颈动脉粥样硬化疾病的可靠手术技术，并发症和死亡率低。我们经验的独特之处在于术前中风患者数量众多，但尽管如此，结果与先前发表的系列研究相当。这也凸显了全面手术培训在减少并发症方面的重要性。
