Turner D A, Tracy J, Haines S J
Department of Neurosurgery, University of Minnesota, Minneapolis.
J Neurosurg. 1990 Aug;73(2):193-200. doi: 10.3171/jns.1990.73.2.0193.
The long-term outcome following carotid endarterectomy for neurological symptoms was analyzed using a retrospective life-table approach in 212 patients who had undergone 243 endarterectomy procedures. The postoperative follow-up period averaged 38.9 +/- 2.1 months (mean +/- standard error of the mean). The endpoints of stroke and death were evaluated in these patients. Patient groups with the preoperative symptoms of amaurosis fugax, transient ischemic attack, and prior recovered stroke were similar in terms of life-table outcome over the follow-up period. Sixty-two percent of symptomatic patients were alive and free of stroke at 5 years. The late risk of stroke (after 30 days postoperatively) averaged 1.7% per year based on a linear approximation to the hazard at each life-table interval (1.3% per year for ipsilateral stroke). The trend of late stroke risk was clearly downward, however, and could be fitted more accurately by an exponential decay function with a half-life of 33 months. Thus, the risk of stroke following carotid endarterectomy for neurological symptoms was highest in the perioperative period, slowly declined with time, and occurred predominantly ipsilateral to the procedure. The definition of a prospective medical control group remains crucial for a critical analysis of treatment modalities following the onset of premonitory neurological symptoms. In the absence of an adequate control group for this series, the calculated perioperative and postoperative stroke risk from this study was compared to data obtained from the literature on stroke risk in medically treated symptomatic patients. This uncontrolled comparison of treatment modalities suggests the combined perioperative and postoperative stroke risk associated with carotid endarterectomy to be modestly improved over medical treatment alone.
采用回顾性生命表法，对212例接受了243次动脉内膜切除术的患者进行分析，以探讨颈动脉内膜切除术治疗神经症状后的长期预后。术后随访期平均为38.9±2.1个月（均值±均值的标准误）。对这些患者的中风和死亡终点进行了评估。术前有一过性黑矇、短暂性脑缺血发作和既往已恢复中风症状的患者组，在随访期的生命表预后方面相似。62%有症状的患者在5年后存活且无中风。根据每个生命表间隔的风险线性近似值，术后晚期中风风险（术后30天之后）平均每年为1.7%（同侧中风每年1.3%）。然而，晚期中风风险的趋势明显呈下降趋势，并且可以用半衰期为33个月的指数衰减函数更准确地拟合。因此，颈动脉内膜切除术治疗神经症状后的中风风险在围手术期最高，随时间缓慢下降，且主要发生在手术同侧。对于先兆性神经症状出现后治疗方式的批判性分析，前瞻性医学对照组的定义仍然至关重要。由于本系列研究缺乏足够的对照组，因此将本研究计算得出的围手术期和术后中风风险与从文献中获得的药物治疗有症状患者的中风风险数据进行了比较。这种对治疗方式的非对照比较表明，与单纯药物治疗相比，颈动脉内膜切除术相关的围手术期和术后联合中风风险有适度改善。
