Bouziane Zakariyae, Nourissat Ghislain, Duprey Ambroise, Albertini Jean Noel, Favre Jean Pierre, Barral Xavier
Department of vascular surgery, St Etienne University Hospital, St Etienne, France.
Ann Vasc Surg. 2012 Aug;26(6):790-6. doi: 10.1016/j.avsg.2011.09.012. Epub 2012 Apr 24.
Carotid angioplasty and stenting has been proposed as an alternative to carotid endarterectomy (CEA) in patients deemed as at high risk for this surgical procedure. To date, definitely accepted criteria to identify "high-risk" patients for CEA do not exist. Our objective was to assess the relevance of numerous supposed high-risk factors in our experience, as well as their possible effect on our early postoperative results.
A retrospective review of 1,033 consecutive CEAs performed during a 5.6-year period at a single institution was conducted (Vascular Surgery Department, St. Etienne University Hospital, France). Early results in terms of mortality and neurologic events were recorded. Univariate and multivariate analyses for early risk of stroke, myocardial infarction, and death were performed, considering the influence of age, sex, comorbidities, clinical symptoms, and anatomic features.
The cumulative 30-day stroke and death rate was 1.2%. A total of 10 strokes occurred and resulted in three deaths. The postoperative stroke risk was significantly higher in the subgroup of patients treated for symptomatic carotid artery disease: 2,6% (P = 0,004). Univariate analysis and logistic regression did not show statistical significance for 30-day results in any of the considered variables.
Patients with significant medical comorbidities, contralateral carotid occlusion, and high carotid lesions can undergo surgery without increased complications. Those parameters should not be used as exclusion criteria for CEA.
对于被认为进行颈动脉内膜切除术（CEA）手术风险较高的患者，已提出颈动脉血管成形术和支架置入术作为替代方案。迄今为止，尚无明确公认的用于识别CEA“高危”患者的标准。我们的目的是根据我们的经验评估众多假定的高危因素的相关性，以及它们对我们术后早期结果的可能影响。
对在法国圣艾蒂安大学医院血管外科单一机构在5.6年期间连续进行的1033例CEA进行回顾性研究。记录死亡率和神经系统事件方面的早期结果。考虑年龄、性别、合并症、临床症状和解剖特征的影响，对中风、心肌梗死和死亡的早期风险进行单因素和多因素分析。
30天累计中风和死亡率为1.2%。共发生10例中风，导致3例死亡。有症状颈动脉疾病患者亚组的术后中风风险显著更高：2.6%（P = 0.004）。单因素分析和逻辑回归在任何考虑的变量中均未显示30天结果有统计学意义。
有严重内科合并症、对侧颈动脉闭塞和高位颈动脉病变的患者可以接受手术，且并发症不会增加。这些参数不应作为CEA的排除标准。
