Department of Vascular and Endovascular Surgery/Vascular Center, Klinikum rechts der Isar der Technischen Universität München; Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München; AQUA-Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen.
Dtsch Arztebl Int. 2017 Oct 27;114(43):729-736. doi: 10.3238/arztebl.2017.0729.
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) can be used to prevent stroke due to arteriosclerotic lesions of the carotid artery. In Germany, legally mandated quality assurance (QA) enables the evaluation of outcome quality after CEA and CAS performed under routine conditions.
We analyzed data on all elective CEA and CAS procedures performed over the periods 2009-2014 and 2012-2014, respectively. The endpoints of the study were the combined in-hospital stroke and death rate, stroke rate and mortality separately, local complications, and other complications. We analyzed the raw data with descriptive statistics and carried out a risk-adjusted analysis of the association of clinically unalterable variables with the risk of stroke and death. All analyses were performed separately for CEA and CAS.
Data were analyzed from 142 074 CEA procedures (67.8% of them in men) and 13 086 CAS procedures (69.7% in men). The median age was 72 years (CEA) and 71 years (CAS). The periprocedural rate of stroke and death after CEA was 1.4% for asymptomatic and 2.5% for symptomatic stenoses; the corresponding rates for CAS were 1.7% and 3.7%. Variables associated with increased risk included older age, higher ASA class (ASA = American Society of Anesthesiologists), symptomatic vs. asymptomatic stenosis, 50-69% stenosis, and contralateral carotid occlusion (for CEA only).
These data reveal a low periprocedural rate of stroke or death for both CEA and CAS. This study does however not permit any conclusions as to the superiority or inferiority of CEA and CAS.
颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）可用于预防颈动脉粥样硬化性病变引起的中风。在德国，法律规定的质量保证（QA）使我们能够评估在常规条件下进行 CEA 和 CAS 后的结果质量。
我们分析了分别在 2009-2014 年和 2012-2014 年期间进行的所有择期 CEA 和 CAS 手术的数据。该研究的终点是住院期间卒中合并死亡率、单独的卒中率和死亡率、局部并发症和其他并发症。我们使用描述性统计对原始数据进行分析，并对临床不可改变的变量与卒中风险和死亡风险的关联进行风险调整分析。所有分析均分别针对 CEA 和 CAS 进行。
共分析了 142074 例 CEA 手术（其中 67.8%为男性）和 13086 例 CAS 手术（其中 69.7%为男性）。CEA 的中位年龄为 72 岁（男性），CAS 的中位年龄为 71 岁。CEA 无症状狭窄的围手术期卒中死亡率为 1.4%，有症状狭窄为 2.5%；CAS 分别为 1.7%和 3.7%。与风险增加相关的变量包括年龄较大、ASA 分级较高（ASA =美国麻醉医师协会）、无症状与有症状狭窄、50-69%狭窄和对侧颈动脉闭塞（仅适用于 CEA）。
这些数据显示 CEA 和 CAS 的围手术期卒中或死亡风险均较低。然而，本研究并不能得出 CEA 和 CAS 的优劣结论。
