Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada.
Circulation. 2012 Dec 18;126(25):3054-61. doi: 10.1161/CIRCULATIONAHA.112.120030. Epub 2012 Nov 16.
Stroke occurs more commonly after carotid artery stenting than after carotid endarterectomy. Details regarding stroke type, severity, and characteristics have not been reported previously. We describe the strokes that have occurred in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).
CREST is a randomized, open-allocation, controlled trial with blinded end-point adjudication. Stroke was a component of the primary composite outcome. Patients who received their assigned treatment within 30 days of randomization were included. Stroke was adjudicated by a panel of board-certified vascular neurologists with secondary central review of clinically obtained brain images. Stroke type, laterality, timing, and outcome were reported. A periprocedural stroke occurred among 81 of the 2502 patients randomized and among 69 of the 2272 in the present analysis. Strokes were predominantly minor (81%, n=56), ischemic (90%, n=62), in the anterior circulation (94%, n=65), and ipsilateral to the treated artery (88%, n=61). There were 7 hemorrhages, which occurred 3 to 21 days after the procedure, and 5 were fatal. Major stroke occurred in 13 (0.6%) of the 2272 patients. The estimated 4-year mortality after stroke was 21.1% compared with 11.6% for those without stroke. The adjusted risk of death at 4 years was higher after periprocedural stroke (hazard ratio, 2.78; 95% confidence interval, 1.63-4.76).
Stroke, particularly severe stroke, was uncommon after carotid intervention in CREST, but stroke was associated with significant morbidity and was independently associated with a nearly 3-fold increased future mortality. The delayed timing of major and hemorrhagic stroke after revascularization suggests that these strokes may be preventable.
颈动脉支架置入术后比颈动脉内膜切除术更常发生中风。以前没有报告过中风类型、严重程度和特征的详细信息。我们描述了发生在颈动脉血管重建内膜切除术与支架置入术试验（CREST）中的中风。
CREST 是一项随机、开放分配、对照试验，终点判断设盲。中风是主要复合终点的一个组成部分。在随机分组后 30 天内接受指定治疗的患者被纳入。中风由一组经过董事会认证的血管神经科医生进行裁决，并对临床获得的脑部图像进行二次中心审查。报告了中风类型、偏侧性、时间和结果。2502 名随机患者中有 81 名和 2272 名本分析患者中有 69 名发生了围手术期中风。中风主要为轻度（81%，n=56）、缺血性（90%，n=62）、前循环（94%，n=65）和治疗动脉同侧（88%，n=61）。有 7 例出血，发生在手术后 3 至 21 天，其中 5 例为致命性。主要中风发生在 2272 名患者中的 13 名（0.6%）。与无中风的患者相比，中风后 4 年的死亡率估计为 21.1%。4 年后死亡的调整风险在围手术期中风后更高（风险比，2.78；95%置信区间，1.63-4.76）。
在 CREST 中，颈动脉介入治疗后中风，特别是严重中风并不常见，但中风与显著的发病率有关，且与近 3 倍的未来死亡率增加独立相关。再血管化后发生的大卒中和出血性卒中的延迟时间提示这些卒中可能是可预防的。
