Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Acta Neurochir (Wien). 2018 Sep;160(9):1761-1771. doi: 10.1007/s00701-018-3618-5. Epub 2018 Jul 18.
Carotid endarterectomy (CEA) is associated with perioperative stroke and mortality in a minority of cases. The aim of this systematic review and meta-analysis was to investigate the effect of pre-operative statins on perioperative outcomes in patients undergoing CEA for internal carotid artery (ICA) stenosis.
A systematic review of PubMed, Medline, and the Cochrane Database of Systematic Reviews was performed. Studies were included which reported perioperative stroke and/or survival outcomes following CEA for ICA stenosis and compared patients who were and were not taking pre-operative statins. Relevant data were extracted and pooled using meta-analysis.
Seven studies met the inclusion criteria, comprising 21,387 patients. A total of 68.9% (14,976) were administered statins and 31.1% (6657) were statin-free. Pre-operative statin use was higher in patients with a history of cardiac disease (12.2 vs. 23.6% in the statin-free group), diabetes (31.6 vs. 25.1% in the statin-free group), and hypertension (83.5 vs. 72.2% in the statin-free group), while a greater proportion of statin-free patients had symptomatic disease (44.9 vs. 55.5% in the statin-free group). Statins were associated with reduced perioperative stroke in all patients (OR 0.57; 95% CI 0.34-0.95; p = 0.03) and in symptomatic patients (OR 0.57; 95% CI 0.35-0.93; p = 0.03). A trend towards lower perioperative mortality (OR 0.54; 95% CI 0.29, 1.03; p = 0.06) and significantly improved overall survival was observed in the statin group (HR 0.69; 95% CI 0.59-0.81; p < 0.001) at a mean follow-up of 62 months (range 27-76 months).
Administration of statins before CEA is associated with lower rates of perioperative stroke and improved overall survival. Compliance with optimal medical treatment associated with the use of pre-operative statins may limit the clinical significance of these findings. Future investigation to characterize the potential benefit of statin therapy in patients undergoing CEA for ICA stenosis is warranted.
颈动脉内膜切除术（CEA）在少数情况下与围手术期中风和死亡率相关。本系统评价和荟萃分析的目的是研究术前他汀类药物对颈内动脉（ICA）狭窄患者行 CEA 的围手术期结局的影响。
对 PubMed、Medline 和 Cochrane 系统评价数据库进行系统检索。纳入报告了 ICA 狭窄行 CEA 后围手术期中风和/或生存结局并比较了服用和未服用术前他汀类药物的患者的研究。使用荟萃分析提取和汇总相关数据。
符合纳入标准的 7 项研究共纳入 21387 例患者。其中 68.9%（14976 例）接受了他汀类药物治疗，31.1%（6657 例）未服用他汀类药物。有心脏病史（他汀类药物组 12.2%，他汀类药物组 23.6%）、糖尿病（他汀类药物组 31.6%，他汀类药物组 25.1%）和高血压（他汀类药物组 83.5%，他汀类药物组 72.2%）的患者术前使用他汀类药物的比例较高，而他汀类药物组无症状疾病的比例较高（他汀类药物组 44.9%，他汀类药物组 55.5%）。他汀类药物可降低所有患者（OR 0.57；95%CI 0.34-0.95；p=0.03）和症状性患者（OR 0.57；95%CI 0.35-0.93；p=0.03）的围手术期中风。在他汀类药物组中观察到围手术期死亡率（OR 0.54；95%CI 0.29,1.03；p=0.06）有降低趋势，且整体生存率显著提高（HR 0.69；95%CI 0.59-0.81；p<0.001），平均随访时间为 62 个月（27-76 个月）。
CEA 前使用他汀类药物可降低围手术期中风发生率并提高整体生存率。与使用术前他汀类药物相关的最佳药物治疗的依从性可能会限制这些发现的临床意义。有必要进一步研究他汀类药物治疗在 ICA 狭窄患者行 CEA 中的潜在获益。
