From the Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom (A.S.J., S.W., K.H., D.A.C.).
St George's University Hospitals NHS Foundation Trust, London, United Kingdom (I.M.L.).
Stroke. 2019 Sep;50(9):2461-2468. doi: 10.1161/STROKEAHA.119.025231. Epub 2019 Jul 22.
Background and Purpose- Carotid endarterectomy (CEA) reduces the risk of stroke in recently symptomatic patients and less so in asymptomatic patients. Recent evidence suggests that the number of CEAs may be declining. The aim of this study was to investigate annual patterns of CEA in asymptomatic and symptomatic patients in England from 2011 to 2017. Methods- Data from the National Vascular Registry were used to describe (1) the number of CEA procedures in England and its 9 geographic regions from 2011 to 2017, (2) the characteristics of patients undergoing CEA, and (3) whether rates of CEA correlated with the number of vascular arterial units within each region. Annual stroke incidence for each region was derived from official population figures and the number of index stroke admissions per year. Results- The overall number of CEAs performed in England fell from 4992 in 2011 to 3482 in 2017, a 30% decline. Among symptomatic patients, there was a 25% decline, the number of CEAs falling from 4270 to 3217. In asymptomatic patients, there were 722 CEAs performed in 2011 and 265 in 2017, a 63% decline. CEAs per 100 000 adults within all regions declined over time but the size of change varied across the regions (range, 1.7-5.5 per 100 000). The regional numbers of CEAs per year were associated with changes in the regional stroke incidence, the proportion of CEAs performed in asymptomatic patients, and the number of hospitals performing CEA. Conclusions- This population-based study revealed a 63% decline in CEAs among asymptomatic patients between 2011 and 2017, possibly because of changing attitudes in the role of CEA. Reasons for the 25% decline in CEAs among symptomatic patients are unclear as UK guidelines on CEA have not changed for these patients. Whether the proportion of symptomatic patients with 50% to 99% ipsilateral stenosis has changed requires investigation.
背景与目的-颈动脉内膜切除术（CEA）可降低近期症状性患者和无症状患者的中风风险。最近的证据表明，CEA 的数量可能正在下降。本研究的目的是调查 2011 年至 2017 年期间英国无症状和有症状患者的 CEA 年度模式。方法-使用国家血管登记处的数据，描述了（1）2011 年至 2017 年英格兰的 CEA 手术数量及其 9 个地区，（2）接受 CEA 的患者的特征，以及（3）CEA 率是否与每个地区的血管动脉单位数量相关。每个地区的年度中风发病率是根据官方人口数据和每年的指数中风入院人数得出的。结果-英格兰进行的 CEA 总数从 2011 年的 4992 例下降到 2017 年的 3482 例，下降了 30%。在有症状的患者中，下降了 25%，CEA 从 4270 例下降到 3217 例。在无症状患者中，2011 年进行了 722 例 CEA，2017 年进行了 265 例，下降了 63%。所有地区的每 10 万成年人 CEA 数量随着时间的推移而下降，但变化幅度在各地区之间有所不同（范围为每 10 万人 1.7-5.5 例）。每年 CEA 的区域数量与区域中风发病率的变化、无症状患者中 CEA 的实施比例以及实施 CEA 的医院数量相关。结论-这项基于人群的研究显示，2011 年至 2017 年间，无症状患者的 CEA 数量下降了 63%，这可能是由于 CEA 作用的观念发生了变化。有症状患者的 CEA 数量下降 25%的原因尚不清楚，因为英国针对这些患者的 CEA 指南没有改变。需要调查 50%-99%同侧狭窄的有症状患者比例是否发生了变化。
