Cho Sung-Min, Deshpande Abhishek, Pasupuleti Vinay, Hernandez Adrian V, Uchino Ken
From the Cerebrovascular Center, Neurological Institute (S.-M.C., K.U.), and Medicine Institute (A.D.), Cleveland Clinic, Cleveland, OH; Case Western Reserve University (V.P.), Cleveland, OH; School of Medicine (A.V.H.), Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru; and University of Connecticut/Hartford Hospital Evidence-Based Practice Center (A.V.H.).
Neurology. 2017 Nov 7;89(19):1977-1984. doi: 10.1212/WNL.0000000000004626. Epub 2017 Oct 11.
In a systematic review, we compared ratio of new periprocedural radiographic brain ischemia (RBI) to the number of strokes and TIAs among patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS).
We searched 5 databases for entries related to brain ischemia in CEA or CAS from inception through September 2015. We included articles with CEA or CAS and systematic performance of preprocedural and postprocedural brain MRI and reporting of RBI and stroke incidence. We calculated a symptomatic risk ratio of number of strokes and TIAs to RBI. Random effects models were used.
Fifty-nine studies (5,431 participants) met the inclusion criteria. There were 22 cohorts in CEA, 34 in CAS with distal protection, 8 in CAS with proximal protection, 9 in CAS without protection, and 9 in CAS with unspecified devices. Overall, 30.7% (95% confidence interval [CI] 26.6%-34.7%) had RBI, while 3.2% (95% CI 2.6%-3.8%) had clinical strokes or TIAs, with a stroke and TIA to RBI weighted ratio of 0.18 (95% CI 0.15-0.22). CEA had lower incidence of RBI compared to CAS (13.0% vs 37.4%) and also lower number of strokes and TIAs (1.8% vs 4.1%). The stroke and TIA to RBI ratio did not differ across 5 different types of carotid interventions ( = 0.58).
One in 5 persons with periprocedural radiographic brain ischemia during CEA and CAS had strokes and TIAs. The stable ratio of stroke and TIA to radiographic ischemia suggests that MRI ischemia could serve as a surrogate measure of periprocedural risk.
在一项系统评价中，我们比较了接受颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）的患者中新发围手术期放射性脑缺血（RBI）与中风和短暂性脑缺血发作（TIA）数量的比率。
我们检索了5个数据库，以查找从数据库建立至2015年9月期间与CEA或CAS中脑缺血相关的条目。我们纳入了涉及CEA或CAS以及术前和术后脑MRI系统检查以及RBI和中风发生率报告的文章。我们计算了中风和TIA数量与RBI的症状风险比率。使用随机效应模型。
59项研究（5431名参与者）符合纳入标准。其中CEA队列22项，有远端保护装置的CAS队列34项，有近端保护装置的CAS队列8项，无保护装置的CAS队列9项，装置未明确的CAS队列9项。总体而言，30.7%（95%置信区间[CI] 26.6%-34.7%）发生RBI，而3.2%（95% CI 2.6%-3.8%）发生临床中风或TIA，中风和TIA与RBI的加权比率为0.18（95% CI 0.15-0.22）。与CAS相比，CEA的RBI发生率较低（13.0%对37.4%），中风和TIA的数量也较少（1.8%对4.1%）。在5种不同类型的颈动脉干预中，中风和TIA与RBI的比率没有差异（ = 0.58）。
在CEA和CAS期间，每5名发生围手术期放射性脑缺血患者中就有1人发生中风和TIA。中风和TIA与放射性缺血的稳定比率表明，MRI缺血可作为围手术期风险的替代指标。
