Wu Tiffany Y, Akopian Gabriel, Katz Steven G
Department of Surgery, Keck School of Medicine, University of Southern California, Pasadena, CA 91105, USA.
Department of Surgery, Keck School of Medicine, University of Southern California, Pasadena, CA 91105, USA.
Am J Surg. 2015 Jun;209(6):1069-73. doi: 10.1016/j.amjsurg.2014.07.011. Epub 2014 Oct 22.
Carotid endarterectomy (CEA) as treatment in patients with asymptomatic carotid stenosis is the subject of much debate.
The National Surgical Quality Improvement Program database from 2005 to 2012 was queried. Patients undergoing CEA for asymptomatic carotid stenosis were identified. Preoperative risk factors and patient demographics were compared using chi-square analysis and logistic regression to determine their relation with stroke and death.
During an 8-year period, 24,211 CEAs performed for asymptomatic carotid stenosis were identified. Patients with dependent functional status (12.5%), recent myocardial infarction (6.3%), chronic heart failure (5.0%), hypoalbuminemia (4.8%), angina (4.1%), dialysis dependence (3.4%), steroid dependence (3.4%), chronic obstructive pulmonary disease (3.3%), and American Society of Anesthesiologists > 3 (3.2%) had a clinically significant increase in risk of stroke and death. Patients with none of the above risk factors had a stroke and death rate of 1.08%, which was significantly less than the overall stroke and death rate (P < .001).
A high-risk subset of patients undergoing CEA for asymptomatic carotid stenosis can be identified. If patient selection is optimized and perioperative morbidity and mortality are minimized, CEA will continue to play an important role in stroke prevention for those with significant asymptomatic carotid stenosis.
颈动脉内膜切除术（CEA）作为无症状性颈动脉狭窄患者的治疗方法存在诸多争议。
查询2005年至2012年的国家外科质量改进计划数据库。确定接受CEA治疗无症状性颈动脉狭窄的患者。使用卡方分析和逻辑回归比较术前危险因素和患者人口统计学特征，以确定它们与中风和死亡的关系。
在8年期间，共确定了24211例因无症状性颈动脉狭窄而进行的CEA手术。功能依赖状态（12.5%）、近期心肌梗死（6.3%）、慢性心力衰竭（5.0%）、低白蛋白血症（4.8%）、心绞痛（4.1%）、透析依赖（3.4%）、类固醇依赖（3.4%）、慢性阻塞性肺疾病（3.3%）以及美国麻醉医师协会分级>3（3.2%）的患者，中风和死亡风险有临床意义的显著增加。无上述任何危险因素的患者中风和死亡率为1.08%，显著低于总体中风和死亡率（P<.001）。
可以识别出接受CEA治疗无症状性颈动脉狭窄的高危患者亚组。如果优化患者选择并将围手术期发病率和死亡率降至最低，CEA将继续在预防有显著无症状性颈动脉狭窄患者的中风方面发挥重要作用。
