对于频繁发作和单次短暂性脑缺血发作的紧急颈动脉血运重建的不同情况。
The different scenarios of urgent carotid revascularization for crescendo and single transient ischemic attack.
作者信息
Pini Rodolfo, Faggioli Gianluca, Gargiulo Mauro, Gallitto Enrico, Cacioppa Laura M, Vacirca Andrea, Pisano Emilio, Pilato Alessandro, Stella Andrea
机构信息
1 Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy.
2 Vascular Surgery, Ospedale Maggiore, Bologna, Italy.
出版信息
Vascular. 2019 Feb;27(1):51-59. doi: 10.1177/1708538118799225. Epub 2018 Sep 7.
OBJECTIVE
Carotid stenosis with crescendo-transient-ischemic-attack (cTIA) requires a prompt intervention to reduce the stroke risk. Few data are reported in literature about cTIA suggesting a different perioperative risk compared with patients with single TIA (sTIA). This study aimed to compare the outcome of carotid endarterectomy (CEA) in patients with TIA (single/crescendo) and evaluate the outcome risk-factors.
METHODS
Data from two tertiary hospitals for vascular treatment were analyzed from 2007 to 2016. All patients with TIA subjected to CEA were considered, comparing the 30-day postoperative stroke and stroke/death in patients with cTIA and sTIA, particularly in the urgent (≤48 h) setting.
RESULTS
On a total of 3866 CEA, 888 (23%) were performed in symptomatic patients and 515 for TIA: 365 (71%) patients with sTIA and 150 (29%) with cTIA. When compared with sTIA, cTIA patients were younger and less frequently affected by coronary disease, dyslipidemia, and chronic pulmonary disease; however, contralateral carotid occlusion was more common (20% vs. 10%, P = .004; 56% vs. 46, P = .03; 16% vs. 7%, P = .01; >80 years 26% vs. 16%, P = .01 and 2% vs. 10%, P = .001; respectively). Postoperative stroke and stroke/death were significantly higher in cTIA compared with sTIA (5.3% vs. 1.6%, P = .02 and 6.0% vs. 2.2%, P = .03; respectively). Urgent CEA was performed in 58% ( n: 87) cTIA and in 11% ( n: 56) sTIA( P<.01). The urgent setting did not influence the stroke and stroke/death rate of CEA for sTIA (3.6% vs. 1.3%, P = .21 and 3.6% vs. 1.9%, P = .44, respectively), but was associated with lower rate of events in cTIA (1.1%vs. 11.1%, P = .01 and 2.3% vs. 11.1%, P = .03, respectively). This beneficial effect in patients with cTIA treated within 48-h was confirmed also by multivariate analysis (OR: 0.09, 95% CI: 0.76-0.01, P=.02).
CONCLUSIONS
cTIA subjected to CEA have a higher stroke and stroke/death risk compared with patients with sTIA. The urgent setting seems to reduce the stroke/death rate cTIA; for sTIA with a stable neurological condition, the timing of CEA did not influence the outcome.
目的
伴有渐进性短暂性脑缺血发作（cTIA）的颈动脉狭窄需要及时干预以降低中风风险。文献中关于cTIA的报道较少，提示其围手术期风险与单次短暂性脑缺血发作（sTIA）患者不同。本研究旨在比较TIA（单次/渐进性）患者行颈动脉内膜切除术（CEA）的结果，并评估结果的风险因素。
方法
分析2007年至2016年两家三级血管治疗医院的数据。纳入所有接受CEA的TIA患者，比较cTIA和sTIA患者术后30天的中风及中风/死亡情况，特别是在紧急情况（≤48小时）下。
结果
在总共3866例CEA手术中，888例（23%）在有症状患者中进行，其中515例为TIA患者：365例（71%）为sTIA患者，150例（29%）为cTIA患者。与sTIA相比，cTIA患者更年轻，患冠心病、血脂异常和慢性肺病的频率更低；然而，对侧颈动脉闭塞更常见（分别为20%对10%，P = 0.004；56%对46%，P = 0.03；16%对7%，P = 0.01；>80岁为26%对16%，P = 0.01；2%对10%，P = 0.001）。与sTIA相比，cTIA患者术后中风及中风/死亡发生率显著更高（分别为5.3%对1.6%，P = 0.02；6.0%对2.2%，P = 0.03）。58%（n = 87）的cTIA患者和11%（n = 56）的sTIA患者进行了紧急CEA（P<0.01）。紧急情况对sTIA患者CEA的中风及中风/死亡发生率无影响（分别为3.6%对1.3%，P = 0.21；3.6%对1.9%，P = 0.44），但与cTIA患者较低的事件发生率相关（分别为1.1%对11.1%，P = 0.01；2.3%对11.1%，P = 0.03）。多因素分析也证实了在48小时内接受治疗的cTIA患者具有这种有益效果（OR：0.09，95%CI：0.76 - 0.01，P = 0.02）。
结论
与sTIA患者相比，接受CEA的cTIA患者中风及中风/死亡风险更高。紧急情况似乎可降低cTIA患者的中风/死亡率；对于神经状况稳定的sTIA患者，CEA的时机不影响结果。
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