Mizuhashi Satomi, Kataoka Hiroharu, Sano Noritaka, Ideguchi Minoru, Higashi Masahiro, Miyamoto Yoshihiro, Iihara Koji
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
Acta Neurochir (Wien). 2014 May;156(5):927-33. doi: 10.1007/s00701-014-2040-x. Epub 2014 Mar 15.
Published results for carotid endarterectomy (CEA) in symptomatic and asymptomatic severe carotid stenosis with diabetes mellitus (DM) are contradictory. To evaluate perioperative and long-term results of CEA in patients with DM, we retrospectively analyzed data of patients with or without DM who underwent CEA in our institute.
Between January 2005 and December 2010, 281 consecutive CEAs were performed in 268 patients under general anesthesia. All patients were subject to cardiac work-ups before surgery, and coronary revascularization was performed prior to CEA if patients were diagnosed with significant coronary artery stenosis. Lesion characteristics were assessed by a duplex ultrasound scan, computed tomography angiography (CTA), and plaque imaging on magnetic resonance imaging (MRI) before surgery, and patients were followed-up by a duplex ultrasound scan at three, six, and 12 months, then yearly, after surgery.
Of 281 cases, 136 had DM (48 %). Diabetic patients more frequently had a history of coronary artery disease than non-diabetic patients (48.5 % vs. 36.6 %, P = 0.042). Coronary intervention prior to CEA was more frequently performed in diabetic patients than in non-diabetic patients (22.1 % vs. 11.0 %, P = 0.013). The incidence of perioperative (30 day) stroke (P = 1.000), death (P = 1.000), and cardiac complications (P = 0.484) did not differ among groups. Follow-up was available in 77.2 % of patients, with a median duration of 50 months (interquartile range, 32.1-67.2 months). The incidence of ipsilateral stroke (P = 0.720), death (P = 0.351), and severe restenosis (peak systolic velocity > 230 cm/sec) (P = 0.905) were not different between groups.
DM does not increase the risk of perioperative complications and does not influence long-term outcomes after CEA if preexisting vascular risk factors and cardiac diseases are appropriately evaluated and treated before surgery.
关于有症状和无症状的重度颈动脉狭窄合并糖尿病（DM）患者行颈动脉内膜切除术（CEA）的已发表结果相互矛盾。为评估DM患者行CEA的围手术期和长期结果，我们回顾性分析了在我院接受CEA的有或无DM患者的数据。
2005年1月至2010年12月期间，268例患者在全身麻醉下连续进行了281次CEA。所有患者在手术前均接受心脏检查，若患者被诊断为严重冠状动脉狭窄，则在CEA之前进行冠状动脉血运重建。术前通过双功超声扫描、计算机断层血管造影（CTA）和磁共振成像（MRI）上的斑块成像评估病变特征，术后在3个月、6个月和12个月时通过双功超声扫描进行随访，然后每年随访一次。
281例病例中，136例患有DM（48%）。糖尿病患者比非糖尿病患者更常患有冠状动脉疾病史（48.5%对36.6%，P = 0.042）。糖尿病患者在CEA之前进行冠状动脉介入治疗的频率高于非糖尿病患者（22.1%对11.0%，P = 0.013）。围手术期（30天）中风（P = 1.000）、死亡（P = 1.000）和心脏并发症（P = 0.484）的发生率在各组之间没有差异。77.2%的患者有随访，中位随访时间为50个月（四分位间距，32.1 - 67.2个月）。同侧中风（P = 0.720）、死亡（P = 0.351）和严重再狭窄（收缩期峰值速度>230 cm/秒）（P = 0.905）的发生率在各组之间没有差异。
如果在手术前对已存在的血管危险因素和心脏疾病进行适当评估和治疗，DM不会增加围手术期并发症的风险，也不会影响CEA后的长期结果。
