Kretz Benjamin, Abello Nicolas, Astruc Karine, Terriat Beatrice, Favier Claire, Bouchot Olivier, Brenot Roger, Steinmetz Eric
Service de Chirurgie Cardio-vasculaire, CHU Le Bocage, Dijon, France.
Ann Vasc Surg. 2012 Aug;26(6):766-74. doi: 10.1016/j.avsg.2011.12.009. Epub 2012 Jun 19.
Any obstacle in the contralateral artery has long been considered a high risk for carotid surgery. Here, we report the results of a monocentric, continuous, consecutive, prospective series and present a review of the literature.
All carotid endarterectomies performed under locoregional anesthesia in our department between 2003 and 2010 were recorded in a prospective database (n = 1,212). Different statuses of the contralateral carotid artery--occlusion (group O, n = 81) and stenosis of >60% (group S, n = 173)--were compared with a control group (group C, n = 958). A shunt was used in cases of clinical intolerance to clamping. The assessment criteria concerned the need for a shunt and the combined 30-day nonfatal stroke and death rate. A stepwise logistic regression was performed.
Overall, a shunt was necessary in 7.3% of cases. The proportion was greater in group O (25.9%, P < 0.001). Severe renal insufficiency (odds ratio [OR] = 1.94) and contralateral carotid occlusion (OR = 5.53) were the sole factors predicting the need for shunting. The overall 30-day nonfatal stroke and death rate was 2.5%, with no difference between groups (P = 0.738), and severe renal insufficiency was the single predictor of a poor outcome (OR = 3.11; 95% confidence interval: 1.21-7.97; P = 0.18).
In this series, and in a large review of literature, occlusion of the contralateral internal carotid artery increased the incidence of intolerance to clamping and thus the use of shunts but did not worsen postoperative morbidity and mortality. The presence of a stenosed contralateral carotid was not predictive of postoperative events. In our experience, the status of the contralateral carotid artery cannot be considered a high risk for carotid surgery.
长期以来，对侧动脉的任何病变都被视为颈动脉手术的高风险因素。在此，我们报告一项单中心、连续、连贯、前瞻性系列研究的结果，并对相关文献进行综述。
2003年至2010年间在我科接受局部区域麻醉下行颈动脉内膜切除术的所有患者均记录于前瞻性数据库中（n = 1212）。将对侧颈动脉的不同状态——闭塞（O组，n = 81）和狭窄>60%（S组，n = 173）——与对照组（C组，n = 958）进行比较。对于夹闭时出现临床不耐受的病例使用分流管。评估标准包括是否需要分流管以及30天非致死性卒中与死亡率的综合情况。进行逐步逻辑回归分析。
总体而言，7.3%的病例需要使用分流管。O组的比例更高（25.9%，P < 0.001）。严重肾功能不全（比值比[OR] = 1.94）和对侧颈动脉闭塞（OR = 5.53）是预测需要分流的唯一因素。30天非致死性卒中和死亡率总体为2.5%，各组之间无差异（P = 0.738），严重肾功能不全是预后不良的唯一预测因素（OR = 3.11；95%置信区间：1.21 - 7.97；P = 0.18）。
在本系列研究以及大量文献综述中，对侧颈内动脉闭塞增加了夹闭不耐受的发生率，进而增加了分流管的使用，但并未使术后发病率和死亡率恶化。对侧颈动脉狭窄并非术后事件的预测因素。根据我们的经验，对侧颈动脉状态不能被视为颈动脉手术的高风险因素。
