Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.
Eur J Vasc Endovasc Surg. 2018 Nov;56(5):622-631. doi: 10.1016/j.ejvs.2018.07.015. Epub 2018 Aug 23.
The optimum timing of carotid intervention for symptomatic carotid stenosis remains unclear. The objective was to investigate outcomes of very urgent (< 48 h from neurological event) in comparison to urgent (≥ 48 h from neurological event) carotid intervention for symptomatic carotid disease.
A systematic literature review was carried out of randomised control trials (RCTs) and observational studies reporting peri-procedural outcomes of carotid intervention in relation to the length of time since the neurological event (PROSPERO registration number: CRD 42017075766). Ipsilateral stroke and death were defined as the primary outcome endpoints. Transient ischaemic attack (TIA) and myocardial infarction (MI) were secondary outcome parameters. Comparative outcomes were calculated and reported as dichotomous outcome measures using the odds ratio (OR) and associated 95% confidence interval (CI) for very urgent (< 48 h since neurological event) versus urgent (≥ 48 h) intervention. The combined overall effect size was calculated using a random effects model.
Twelve observational studies and one RCT representing 5751 interventions, 5385 carotid endarterectomies (CEAs) and 366 carotid artery stenting (CAS) procedures, were included in quantitative synthesis. Very urgent carotid intervention was associated with increased risk of stroke within 30 days of treatment compared with urgent carotid intervention (OR 2.19, 95% CI 1.46-3.26, p < .001). No significant difference was found in mortality (OR 1.55, 95% CI 0.81-2.96, p = .19), TIA (OR 1.33, 95% CI 0.55-3.19, p = .52) or MI (OR 1.33, 95% CI 0.41-4.33, p = .64).
Very urgent carotid intervention was found to be associated with increased risk of stroke.
症状性颈动脉狭窄的颈动脉介入治疗的最佳时机仍不清楚。本研究旨在探讨与神经系统事件发生后时间（非常紧急（<48 小时）与紧急（≥48 小时））相关的症状性颈动脉疾病的颈动脉介入治疗的结果。
对随机对照试验（RCT）和观察性研究进行了系统的文献回顾，这些研究报告了与神经系统事件发生后时间相关的颈动脉介入治疗的围手术期结果（PROSPERO 注册号：CRD42017075766）。同侧卒中与死亡被定义为主要终点。短暂性脑缺血发作（TIA）和心肌梗死（MI）为次要终点参数。使用优势比（OR）和 95%置信区间（CI）计算并报告非常紧急（<48 小时）与紧急（≥48 小时）干预的对比结果，作为二项式结果测量。使用随机效应模型计算总体综合效应量。
纳入了 12 项观察性研究和 1 项 RCT，共计 5751 项干预措施，5385 例颈动脉内膜切除术（CEA）和 366 例颈动脉支架置入术（CAS）。非常紧急的颈动脉介入治疗与治疗后 30 天内卒中风险增加相关（OR2.19，95%CI1.46-3.26，p<0.001）。未发现死亡率（OR1.55，95%CI0.81-2.96，p=0.19）、TIA（OR1.33，95%CI0.55-3.19，p=0.52）或 MI（OR1.33，95%CI0.41-4.33，p=0.64）的差异有统计学意义。
非常紧急的颈动脉介入治疗与卒中风险增加相关。
