Callow A D, Mackey W C
Department of Surgery, Tufts University, Boston, Massachusetts.
Ann Surg. 1989 Sep;210(3):308-15; discussion 315-6. doi: 10.1097/00000658-198909000-00006.
To document the efficacy of our aggressive surgical approach to stroke prevention, we compiled follow-up data on 619 patients undergoing 993 carotid endarterectomies at our institution since 1970. Following carotid endarterectomy, crude annual stroke incidence, including perioperative strokes (2.2%), was 1.9%. In our symptomatic patients crude annual stroke incidence, including perioperative strokes (2.7%), was 2.1%. This is superior to the annual stroke incidence seen in patients on "optimal" medical therapy as defined by the Canadian Cooperative Study (4.6% in men), the AICLA Study (2.9%), the American Multicenter Trial (8%), and the Canadian- American Cooperative Trial (approximately 5%). In our asymptomatic patients, crude annual stroke incidence, including perioperative strokes (1.1%), was 1.4%. This is superior to nonsurgical therapy for asymptomatic patients with hemodynamically significant or more than 75% stenoses as reported by the Mayo Clinic (3.4%) or Chambers and Norris (2.7%). An aggressive surgical approach to carotid bifurcation atherosclerosis is superior to nonsurgical therapy in symptomatic and selected asymptomatic patients if low perioperative mortality/stroke morbidity rates are achieved.
为记录我们积极的手术方法预防中风的疗效，我们收集了自1970年以来在本机构接受993例颈动脉内膜切除术的619例患者的随访数据。颈动脉内膜切除术后，包括围手术期中风（2.2%）在内的年粗中风发病率为1.9%。在我们的有症状患者中，包括围手术期中风（2.7%）在内的年粗中风发病率为2.1%。这优于加拿大合作研究定义的“最佳”药物治疗患者的年中风发病率（男性为4.6%）、AICLA研究（2.9%）、美国多中心试验（8%）以及加拿大-美国合作试验（约5%）。在我们的无症状患者中，包括围手术期中风（1.1%）在内的年粗中风发病率为1.4%。这优于梅奥诊所（3.4%）或钱伯斯和诺里斯（2.7%）报道的对有血流动力学显著异常或狭窄超过75%的无症状患者的非手术治疗。如果能实现低围手术期死亡率/中风发病率，积极的手术方法治疗颈动脉分叉动脉粥样硬化在有症状和部分无症状患者中优于非手术治疗。
