Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
AQUA-Institut für Angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany.
JACC Cardiovasc Interv. 2017 Jun 26;10(12):1257-1265. doi: 10.1016/j.jcin.2017.03.032.
The aim of this study was to analyze the association between intraprocedural and periprocedural variables and in-hospital stroke or death rate after carotid artery stenting.
In Germany, all open surgical and endovascular procedures on the extracranial carotid artery must be documented in a statutory nationwide quality assurance database.
A total of 13,086 carotid artery stenting procedures for asymptomatic (63.9%) or symptomatic carotid stenosis (mean age 69.7 years, 69.7% men) between 2009 and 2014 were recorded. The following variables were analyzed: stent design, stent material, neurophysiological monitoring, periprocedural antiplatelet medication, and use of an embolic protection device. The primary outcome was in-hospital stroke or death. Major stroke or death, any stroke, and death, all until discharge, were secondary outcomes. Adjusted relative risks (RRs) were assessed using multilevel multivariable regression analyses.
The primary outcome occurred in 2.4% of the population (1.7% in asymptomatic and 3.7% in symptomatic patients). The multivariable analysis showed an independent association between the use of an embolic protection device and lower in-hospital rates of stroke or death (adjusted RR: 0.65; 95% confidence interval [CI]: 0.50 to 0.85), major stroke or death (adjusted RR: 0.60; 95% CI: 0.43 to 0.84), and stroke (adjusted RR: 0.57; 95% CI: 0.43 to 0.77). Regarding the occurrence of in-hospital death, there was no significant association (adjusted RR: 0.78; 95% CI: 0.46 to 1.35). None of the outcomes was associated with stent design, stent material, neurophysiological monitoring, or antiplatelet medication.
The use of an embolic protection device was independently associated with lower in-hospital risk for stroke or death, major stroke or death, and stroke.
本研究旨在分析颈动脉支架置入术围手术期和围手术期变量与住院期间卒中或死亡率之间的关系。
在德国，所有颅外颈动脉的开放性手术和血管内治疗程序都必须在法定的全国质量保证数据库中记录。
共记录了 2009 年至 2014 年间 13086 例无症状（63.9%）或症状性颈动脉狭窄（平均年龄 69.7 岁，69.7%为男性）患者的颈动脉支架置入术。分析了支架设计、支架材料、神经生理监测、围手术期抗血小板治疗以及使用栓塞保护装置等变量。主要结局为住院期间卒中或死亡。次要结局为主要卒中和死亡、任何卒中和死亡，直至出院。使用多水平多变量回归分析评估调整后的相对风险（RR）。
该人群的主要结局发生率为 2.4%（无症状患者为 1.7%，症状性患者为 3.7%）。多变量分析显示，使用栓塞保护装置与住院期间卒中或死亡率（调整 RR：0.65；95%置信区间 [CI]：0.50 至 0.85）、主要卒中和死亡（调整 RR：0.60；95% CI：0.43 至 0.84）和卒中（调整 RR：0.57；95% CI：0.43 至 0.77）的发生率降低独立相关。至于住院期间死亡的发生，两者无显著相关性（调整 RR：0.78；95% CI：0.46 至 1.35）。支架设计、支架材料、神经生理监测或抗血小板治疗与任何结局均无关。
栓塞保护装置的使用与住院期间卒中或死亡、主要卒中和死亡以及卒中的风险降低独立相关。
