Anaesthesiology and Critical Care Department, Dr. Peset University Hospital, Valencia, Spain.
Arch Med Sci. 2012 May 9;8(2):236-43. doi: 10.5114/aoms.2012.28550.
To assess the possible role and the interaction of cerebrovascular disease and vascular stenosis on the necessity of shunt insertion during carotid endarterectomy (CEA).
Eighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student's t and χ(2) tests were used (p<0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald's test (p<0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models.
Contralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis ≥ 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p=0.003) for shunt (RR=1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2.
The findings suggest that patients with contralateral stenosis ≥ 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately.
评估脑血管疾病和血管狭窄在颈动脉内膜切除术（CEA）中分流插入必要性的可能作用和相互作用。
连续 80 例在区域麻醉下接受 CEA 的患者前瞻性入组。根据是否分流，患者分为两组。测量的终点包括共病程度、对侧和颈动脉狭窄以及其他围手术期突出参数。使用 ANOVA、Student's t 和 χ(2)检验（p<0.05）。在向后逐步逻辑回归中，使用组间差异显著的变量和潜在混杂因素来估计分流的相对风险（RR，95%CI）。此外，还使用 Wald 检验（p<0.05），并在存在和不存在潜在混杂因素的情况下，使用各种不同的多变量分析模型。
分流患者更常观察到对侧狭窄和脑血管意外（CVA）。对侧狭窄≥50%的患者 RR 为 1.3（95%CI 1.0-1.5），既往 CVA 患者的 RR 为 1.2（95%CI 1.0-1.4）。对于对侧狭窄和 CVA 同时，RR 增加到 7.7（95%CI 1.0-14.4）。基于对侧狭窄和 CVA 的模型发现对分流有统计学意义（p=0.003）（RR=1.1，95%CI 1.0-2.1）。由于这两个因素相互作用导致的相对额外风险为 6.2。
研究结果表明，对侧狭窄≥50%和既往 CVA 的患者在 CEA 中比仅具有这些危险因素的患者更需要分流。
