Wen Lan, Wang Suxia, Liu Lei, Chen Lin, Geng Jia, Kuang Lei, Qian Gangzhen, Su Junjie, Chen Kangning, Zhou Zhenhua
Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Department of Pain, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Behav Neurol. 2018 Sep 12;2018:4707104. doi: 10.1155/2018/4707104. eCollection 2018.
Compared to carotid endarterectomy, carotid artery stenting (CAS) is reportedly associated with higher perioperative risks in elderly patients. To verify the long-term safety and efficacy of CAS with embolic protection in elderly patients, we retrospectively reviewed the medical records of patients with carotid stenosis treated between January 2003 and March 2010 at the Department of Neurology of a large university hospital in China. We included patients with symptomatic, moderate, or severe carotid stenosis of atherosclerotic etiology (other etiologies were excluded), with a disability score ≤ 3 on the modified Rankin Scale, and who received CAS instead of carotid endarterectomy. The clinical endpoints studied were stroke recurrence and all-cause death. The 84 patients included in this study (median follow-up, 8.08 years) were stratified according to age at surgery (<70 vs. ≥70 years), and no significant between-group difference was found regarding baseline characteristics. Of the 14 patients (16.67%) who experienced a defined clinical endpoint, 4 (7.14%) were aged <70 years and 10 (35.71%) were aged ≥70 years ( = 0.002). Overall mortality was 14.29% (12/84), with 3 (5.36%) and 9 (32.14%) deaths among patients aged <70 and ≥ 70 years, respectively ( = 0.002). Heart disease and cancer accounted for most deaths. The two groups did not differ regarding stroke recurrence, disability score, or rate of in-stent restenosis (blockage ≥ 50%), but patients aged ≥70 years had a higher risk of mortality (odds ratio, 8.3684; 95% confidence interval, 2.048-34.202; = 0.003), and age was an independent risk factor for death (odds ratio, 20.054; 95% confidence interval, 3.094-129.987, = 0.002). Among elderly patients in Southwest China, CAS can effectively prevent stroke recurrence without increasing the risk of stroke-related death, but the risk of all-cause death is higher, with age as an independent risk factor. Careful patient selection is of key importance in the treatment of symptomatic carotid artery stenosis.
据报道，与颈动脉内膜切除术相比，老年患者接受颈动脉支架置入术（CAS）的围手术期风险更高。为了验证在老年患者中使用栓子保护装置的CAS的长期安全性和有效性，我们回顾性分析了2003年1月至2010年3月在中国一家大型大学医院神经内科接受治疗的颈动脉狭窄患者的病历。我们纳入了因动脉粥样硬化病因导致有症状的中度或重度颈动脉狭窄患者（排除其他病因），改良Rankin量表残疾评分≤3分，且接受CAS而非颈动脉内膜切除术的患者。研究的临床终点为卒中复发和全因死亡。本研究纳入的84例患者（中位随访时间为8.08年）根据手术时年龄（<70岁与≥70岁）进行分层，两组在基线特征方面未发现显著差异。在经历明确临床终点的14例患者（16.67%）中，4例（7.14%）年龄<70岁，10例（35.71%）年龄≥70岁（P = 0.002）。总体死亡率为14.29%（12/84），年龄<70岁和≥70岁的患者分别有3例（5.36%）和9例（32.14%）死亡（P = 0.002）。心脏病和癌症是主要死因。两组在卒中复发、残疾评分或支架内再狭窄率（堵塞≥50%）方面无差异，但年龄≥70岁的患者死亡风险更高（比值比，8.3684；95%置信区间，2.048 - 34.202；P = 0.003），年龄是死亡的独立危险因素（比值比，20.054；95%置信区间，3.094 - 129.987，P = 0.002）。在中国西南部的老年患者中，CAS可有效预防卒中复发，且不增加卒中相关死亡风险，但全因死亡风险更高，年龄是独立危险因素。在有症状的颈动脉狭窄治疗中，仔细选择患者至关重要。
