Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Surgery. 2018 Dec;164(6):1271-1278. doi: 10.1016/j.surg.2018.06.041. Epub 2018 Sep 18.
Carotid artery stenting remains an effective alternative to carotid endarterectomy for stroke prevention; however, the long-term durability of carotid artery stenting remains poorly defined. We performed a 10-year "real-world" comparative analysis of carotid endarterectomy and carotid artery stenting to help evaluate the success of these procedures in preventing late ischemic stroke events.
This was a single-center retrospective review of 996 patients (symptomatic and asymptomatic) treated with carotid endarterectomy or carotid artery stenting from January 2001 through December 2011 at a tertiary academic medical center. All-cause death, stroke, and myocardial infarction event rates were analyzed using log-rank analysis.
Among the 996 patients treated with carotid endarterectomy (n = 787) or carotid artery stenting (n = 209), the 30-day, 1-year, 5-year, and 10-year survival rates for carotid endarterectomy patients were 99.1%, 95.3%, 77.9%, and 54.8%; carotid artery stenting rates were 99.5%, 96.2%, 67.8%, and 40.2%, respectively (P = .005, at 10 years). There was no significant difference in early stroke rates or myocardial infarction rates between the groups. Subgroup analysis comparing symptomatic status demonstrated no statistically significant differences in overall survival, stroke, or myocardial infarction rates at 10 years. In addition to reduced long-term overall survival, carotid artery stenting patients had a higher long-term restenosis rate as compared to carotid endarterectomy (6.3% vs 2.8%, P < .0001) and reduced restenosis-free survival (P = .01).
Early death, stroke, and myocardial infarction rates are comparable after carotid endarterectomy and carotid artery stenting. Carotid artery stenting is an effective means of preventing stroke among patients with carotid artery stenosis. Symptomatic status does not seem to affect rates of stroke, myocardial infarction, or death. Carotid endarterectomy continues to be the preferred long-term solution for extracranial carotid artery occlusive disease as it is associated with better long-term survival and lower restenosis rates.
颈动脉支架置入术仍然是预防中风的一种有效替代颈动脉内膜切除术的方法；然而，颈动脉支架置入术的长期耐久性仍不清楚。我们对颈动脉内膜切除术和颈动脉支架置入术进行了为期 10 年的“真实世界”比较分析，以帮助评估这些手术预防晚期缺血性中风事件的成功。
这是一项单中心回顾性研究，共纳入 996 例（有症状和无症状）于 2001 年 1 月至 2011 年 12 月在一家三级学术医疗中心接受颈动脉内膜切除术或颈动脉支架置入术治疗的患者。使用对数秩分析分析全因死亡、中风和心肌梗死事件发生率。
在 996 例接受颈动脉内膜切除术（n=787）或颈动脉支架置入术（n=209）的患者中，颈动脉内膜切除术患者的 30 天、1 年、5 年和 10 年生存率分别为 99.1%、95.3%、77.9%和 54.8%；颈动脉支架置入术患者的生存率分别为 99.5%、96.2%、67.8%和 40.2%（P=0.005，10 年时）。两组间早期中风率或心肌梗死率无显著差异。比较症状状态的亚组分析显示，10 年时总体生存率、中风或心肌梗死率无统计学差异。除了长期总生存率降低外，与颈动脉内膜切除术相比，颈动脉支架置入术患者的长期再狭窄率更高（6.3%比 2.8%，P<0.0001），且再狭窄无事件生存率更低（P=0.01）。
颈动脉内膜切除术和颈动脉支架置入术后早期死亡、中风和心肌梗死率相当。颈动脉支架置入术是预防颈动脉狭窄患者中风的有效方法。症状状态似乎不会影响中风、心肌梗死或死亡的发生率。颈动脉内膜切除术仍是治疗颅外颈动脉闭塞性疾病的首选长期解决方案，因为它与更好的长期生存率和更低的再狭窄率相关。
