Volkers Eline J, Greving Jacoba P, Hendrikse Jeroen, Algra Ale, Kappelle L Jaap, Becquemin Jean-Pierre, Bonati Leo H, Brott Thomas G, Bulbulia Richard, Calvet David, Eckstein Hans-Henning, Fraedrich Gustav, Gregson John, Halliday Alison, Howard George, Jansen Olav, Roubin Gary S, Brown Martin M, Mas Jean-Louis, Ringleb Peter A
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (E.J.V., A.A., L.J.K.), Julius Center for Health Sciences and Primary Care (E.J.V., J.P.G., A.A.), and Department of Radiology (J.H.), University Medical Center Utrecht, the Netherlands; IVPE (J.-P.B.), Hopital Privé Paul D'Egine Champigny, France; Department of Neurology and Stroke Center (L.H.B.), University Hospital Basel, Switzerland; Department of Brain Repair and Rehabilitation (L.H.B., M.M.B.), UCL Institute of Neurology, University College London, UK; Department of Neurology (T.G.B.), Mayo Clinic, Jacksonville, FL; Clinical Trial Service Unit and Epidemiological Studies Unit (R.B.), Oxford University, UK; Department of Neurology (D.C., J.-L.M.), Hôpital Sainte-Anne, Université Paris-Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, Paris, France; Department of Vascular and Endovascular Surgery/Vascular Center (H.-H.E.), Klinikum rechts der Isar, Technical University Munich, Germany; Department of Vascular Surgery (G.F.), Medical University of Innsbruck, Austria; London School for Hygiene and Tropical Medicine (J.G.); Nuffield Department of Surgical Sciences (A.H.), John Radcliffe Hospital, Oxford, UK; Department of Biostatistics (G.H.), UAB School of Public Health, Birmingham, AL; Clinic for Radiology and Neuroradiology (O.J.), UKSH Campus Kiel, Germany; Cardiovascular Associates of the Southeast (G.S.R.), Birmingham, AL; and Department of Neurology (P.A.R.), University of Heidelberg Medical School, Germany.
Neurology. 2017 May 23;88(21):2052-2060. doi: 10.1212/WNL.0000000000003957. Epub 2017 Apr 26.
To determine whether the obesity paradox exists in patients who undergo carotid artery stenting (CAS) or carotid endarterectomy (CEA) for symptomatic carotid artery stenosis.
We combined individual patient data from 2 randomized trials (Endarterectomy vs Angioplasty in Patients with Symptomatic Severe Carotid Stenosis and Stent-Protected Angioplasty vs Carotid Endarterectomy) and 3 centers in a third trial (International Carotid Stenting Study). Baseline body mass index (BMI) was available for 1,969 patients and classified into 4 groups: <20, 20-<25, 25-<30, and ≥30 kg/m. Primary outcome was stroke or death, investigated separately for the periprocedural and postprocedural period (≤120 days/>120 days after randomization). This outcome was compared between different BMI strata in CAS and CEA patients separately, and in the total group. We performed intention-to-treat multivariable Cox regression analyses.
Median follow-up was 2.0 years. Stroke or death occurred in 159 patients in the periprocedural (cumulative risk 8.1%) and in 270 patients in the postprocedural period (rate 4.8/100 person-years). BMI did not affect periprocedural risk of stroke or death for patients assigned to CAS ( = 0.39) or CEA ( = 0.77) or for the total group ( = 0.48). Within the total group, patients with BMI 25-<30 had lower postprocedural risk of stroke or death than patients with BMI 20-<25 (BMI 25-<30 vs BMI 20-<25; hazard ratio 0.72; 95% confidence interval 0.55-0.94).
BMI is not associated with periprocedural risk of stroke or death; however, BMI 25-<30 is associated with lower postprocedural risk than BMI 20-<25. These observations were similar for CAS and CEA.
确定在因症状性颈动脉狭窄接受颈动脉支架置入术（CAS）或颈动脉内膜切除术（CEA）的患者中是否存在肥胖悖论。
我们合并了来自2项随机试验（症状性严重颈动脉狭窄患者的内膜切除术与血管成形术以及支架保护血管成形术与颈动脉内膜切除术）和第3项试验（国际颈动脉支架置入研究）中3个中心的个体患者数据。1969例患者有基线体重指数（BMI）数据，并分为4组：<20、20至<25、25至<30以及≥30kg/m²。主要结局为卒中或死亡，分别在围手术期和术后阶段（随机分组后≤120天/>120天）进行调查。分别在CAS和CEA患者以及整个组的不同BMI分层之间比较这一结局。我们进行了意向性治疗多变量Cox回归分析。
中位随访时间为2.0年。围手术期有159例患者发生卒中或死亡（累积风险8.1%），术后阶段有270例患者发生（发生率4.8/100人年）。BMI对分配接受CAS（P = 0.39）或CEA（P = 0.77）的患者或整个组（P = 0.48）的围手术期卒中或死亡风险没有影响。在整个组中，BMI为25至<30的患者术后卒中或死亡风险低于BMI为20至<25的患者（BMI 25至<30与BMI 20至<25相比；风险比0.72；95%置信区间0.55 - 0.94）。
BMI与围手术期卒中或死亡风险无关；然而，BMI为25至<30与低于BMI为20至<25的术后风险相关。这些观察结果在CAS和CEA中相似。
