无症状状态持续时间和颈动脉内膜切除术与颈动脉支架置入术在颈动脉血运重建内膜切除术与支架置入术试验中的结果。
Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial.
机构信息
Division of Vascular Surgery, UCLA Medical Center, Los Angeles, Calif.
Department of Neurology, Medical University of South Carolina, Charleston, SC.
出版信息
J Vasc Surg. 2019 Jun;69(6):1797-1800. doi: 10.1016/j.jvs.2018.09.054. Epub 2019 Jan 8.
BACKGROUND
Most carotid revascularization studies define asymptomatic as symptom-free for more than 180 days; however, it is unknown if intervention carries similar risk among those currently asymptomatic but with previous symptoms (PS) vs those who were always asymptomatic (AA).
METHODS
We compared the periprocedural and 4-year risks of PS vs AA patients in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) randomized to carotid endarterectomy (CEA) or carotid artery stenting (CAS)/angioplasty. Proportional hazards models adjusting for age, sex, and treatment were used to assess the risk of periprocedural stroke and/or death (S+D; any S+D during periprocedural period), stroke and death at 4 years (any S+D within the periprocedural period and ipsilateral stroke out to 4 years) and the primary end point at 4 years (any stroke, death, and myocardial infarction within the periprocedural period and ipsilateral stroke out to 4 years). Analysis was performed pooling the CEA-treated and CAS-treated patients, and separately for each treatment.
RESULTS
Of 1181 asymptomatic patients randomized in CREST, 1104 (93%) were AA and 77 (7%) were PS. There was no difference in risk when comparing the AA and PS cohorts in the pooled CAS+CEA population for periprocedural S+D (2.0% vs 1.3%), S+D at 4 years (3.6% vs 3.2%), or the primary end point (5.2% vs 5.8%). There were also no differences among those assigned to CEA (periprocedural S+D, 1.5% vs 0%; S+D at 4 years, 2.7% vs 0%; or primary end point, 5.1% vs 2.4%) or CAS (periprocedural S+D, 2.5% vs 2.8%; S+D at 4 years, 4.4% vs 6.9%; or primary end point, 5.3% vs 9.8%) when analyzed separately.
CONCLUSIONS
In CREST, only a small minority of asymptomatic patients had previous ipsilateral symptoms. The outcomes of periprocedural S+D, periprocedural S+D, and ipsilateral stroke up to 4 years, and the primary end point did not differ for AA patients compared with PS patients.
背景
大多数颈动脉血运重建研究将无症状定义为无症状超过 180 天；然而，目前尚不清楚对于那些目前无症状但有既往症状（PS）的患者与一直无症状（AA）的患者，干预是否具有相似的风险。
方法
我们比较了颈动脉血运重建内膜切除术与支架置入术试验（CREST）中随机接受颈动脉内膜切除术（CEA）或颈动脉血管成形术和支架置入术（CAS）/血管成形术的 PS 与 AA 患者的围手术期和 4 年风险。使用比例风险模型调整年龄、性别和治疗因素，评估围手术期卒中及/或死亡（S+D；围手术期内任何 S+D）、4 年卒中及死亡（围手术期内任何 S+D 和至 4 年的同侧卒中）和 4 年主要终点（围手术期内任何卒中、死亡和心肌梗死和至 4 年的同侧卒中）风险。对 CEA 治疗和 CAS 治疗患者进行了分析，并分别对每个治疗组进行了分析。
结果
在 CREST 中，1181 例无症状患者中，1104 例（93%）为 AA，77 例（7%）为 PS。在 CEA+CAS 混合人群中，AA 与 PS 队列在围手术期 S+D（2.0% vs 1.3%）、4 年 S+D（3.6% vs 3.2%）或主要终点（5.2% vs 5.8%）方面无差异。接受 CEA 治疗的患者（围手术期 S+D，1.5% vs 0%；4 年 S+D，2.7% vs 0%；或主要终点，5.1% vs 2.4%）或 CAS 治疗的患者（围手术期 S+D，2.5% vs 2.8%；4 年 S+D，4.4% vs 6.9%；或主要终点，5.3% vs 9.8%）之间也没有差异。
结论
在 CREST 中，只有一小部分无症状患者有既往同侧症状。与 PS 患者相比，AA 患者围手术期 S+D、围手术期 S+D 和 4 年内同侧卒中以及主要终点的发生率没有差异。
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