Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Eur J Vasc Endovasc Surg. 2012 Jul;44(1):11-7. doi: 10.1016/j.ejvs.2012.04.013. Epub 2012 May 24.
The aim of the study was to analyse variation in carotid surgical practice, results and effectiveness in nine countries.
A total of 48,185 carotid endarterectomies (CEAs) and 4602 carotid artery stenting (CAS) procedures were included in the comparison. A theoretical effectiveness of CEA provision for each country was estimated.
92.6% of the CEAs were performed according to the inclusion criteria based on the current European recommendations and had a theoretical benefit for the patient. The indication for surgery was symptomatic stenosis in 60.1% and this proportion varied between 31.4% in Italy and 100% in Denmark. The overall combined stroke and death rate in symptomatic patients was 2.3%. This varied between rates of 0.9% in Italy and 3.8% in Norway. The overall combined stroke and death rate in asymptomatic patients was 0.9%. It was lowest in Italy at 0.5%, and highest in Sweden at 2.7%. We estimated that the stroke prevention rate per 1000 CEAs varied from 72.9 in Italy to 130.8 in Denmark.
There is significant variation in clinical practice across the participating countries. The theoretical stroke prevention potential of CEA seems to vary between participating countries due to differences in the inclusion criteria.
本研究旨在分析 9 个国家颈动脉手术实践、结果和效果的差异。
共纳入 48185 例颈动脉内膜切除术（CEA）和 4602 例颈动脉支架置入术（CAS）。对每个国家的 CEA 提供情况进行了理论有效性评估。
92.6%的 CEA 符合当前欧洲建议的纳入标准，对患者具有理论获益。手术指征为症状性狭窄占 60.1%，这一比例在意大利为 31.4%，在丹麦为 100%。症状性患者的总体联合卒中死亡率为 2.3%。这一比例在意大利为 0.9%，在挪威为 3.8%。无症状患者的总体联合卒中死亡率为 0.9%。在意大利最低为 0.5%，在瑞典最高为 2.7%。我们估计，每 1000 例 CEA 的卒中预防率在意大利为 72.9，在丹麦为 130.8。
参与国家之间的临床实践存在显著差异。由于纳入标准的差异，CEA 的理论卒中预防潜力似乎在参与国家之间存在差异。
