Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
J Vasc Surg. 2018 Feb;67(2):490-497. doi: 10.1016/j.jvs.2017.07.104. Epub 2017 Sep 21.
We developed a mini-incision eversion carotid endarterectomy (CEA) procedure (the Jikei method CEA) to prevent perioperative embolic stroke. The aim of this study was to retrospectively analyze perioperative and midterm outcomes after the Jikei method CEA.
We evaluated patients with the Jikei method CEA at our institution between January 2006 and June 2014. The primary end point was a major adverse event, which included death, stroke, intracranial hemorrhage, and myocardial infarction, within 30 days of CEA. Secondary end points were postoperative ipsilateral stroke and restenosis.
We retrospectively studied 120 lesions in 110 patients. The mean age was 72.2 ± 8.0 years. With regard to the 120 lesions, 56 lesions (46.7%) were symptomatic and 73 lesions (60.8%) showed ≥90% severe stenosis. The mean length of the skin incision was 3.2 ± 0.5 cm. The mean operative time, volume of blood loss, and internal carotid artery clamp time were 171.0 ± 50.7 minutes, 161.6 ± 110.8 mL, and 35.7 ± 10.8 minutes, respectively. There were three perioperative major adverse events (2.5%), including two strokes (1.7%) and one intracranial hemorrhage (0.8%) resulting from hyperperfusion syndrome. The median postoperative hospital stay was 6 days (range, 2-303 days). The mean follow-up was 3.9 ± 2.2 years. There was no case of ipsilateral stroke during the follow-up period. The freedom from ipsilateral stroke at 5 years was 98.3%. Three lesions (2.5%) developed restenosis. The freedom from restenosis was 97.2% at 5 years. The freedom from reintervention at 5 years was 99.0% because carotid artery stent placement was necessary in one patient with severe restenosis.
The Jikei method CEA was safe and effective in preventing perioperative and midterm stroke.
我们开发了一种微创外翻颈动脉内膜切除术（CEA）（Jikei 方法 CEA），以预防围手术期栓塞性卒中。本研究旨在回顾性分析 Jikei 方法 CEA 的围手术期和中期结果。
我们评估了 2006 年 1 月至 2014 年 6 月期间在我院接受 Jikei 方法 CEA 的患者。主要终点是 CEA 后 30 天内的主要不良事件，包括死亡、卒中和颅内出血、心肌梗死。次要终点是术后同侧卒中和再狭窄。
我们回顾性研究了 110 例患者的 120 处病变。平均年龄为 72.2±8.0 岁。在 120 处病变中，56 处病变（46.7%）为症状性病变，73 处病变（60.8%）显示≥90%严重狭窄。皮肤切口的平均长度为 3.2±0.5cm。平均手术时间、失血量和颈内动脉夹闭时间分别为 171.0±50.7 分钟、161.6±110.8mL 和 35.7±10.8 分钟。有 3 例围手术期主要不良事件（2.5%），包括 2 例卒中（1.7%）和 1 例颅内出血（0.8%），由高灌注综合征引起。中位术后住院时间为 6 天（范围：2-303 天）。平均随访时间为 3.9±2.2 年。随访期间无同侧卒中发生。5 年同侧卒中无复发率为 98.3%。3 处病变（2.5%）发生再狭窄。5 年无再狭窄率为 97.2%。5 年再干预无复发率为 99.0%，因为 1 例严重再狭窄患者需要颈动脉支架置入。
Jikei 方法 CEA 安全有效，可预防围手术期和中期卒中。
