Seo Kwon-Duk, Lee Kyung-Yul, Suh Sang Hyun
Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Neurointervention. 2019 Sep;14(2):82-90. doi: 10.5469/neuroint.2019.00115. Epub 2019 Aug 27.
Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data.
We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least oneyear follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage.
A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173-1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325-1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322-3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA.
Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.
尽管颈动脉内膜切除术（CEA）被推荐用于治疗颈动脉狭窄而非颈动脉支架置入术（CAS），但在韩国，CAS更受青睐。本研究的目的是利用韩国全国保险数据，分析与CEA相比，CAS后的长期疗效。
我们在研究期间，使用与手术或操作相关的多个编码，从健康保险审查与评估服务（HIRA）的全国数据库中获取了所有数据。我们纳入了HIRA数据，其中包括手术后至少一年的随访。与这两种手术相关的结局包括死亡、缺血性中风复发和脑出血入院。
对2007年1月1日至2016年12月31日期间接受CAS或CEA治疗的16,065例符合条件的患者进行了分析。接受CAS和CEA治疗的患者数量分别为12,173例（75.8%）和3,892例（24.2%）。8,976例患者（55.9%）被归类为有症状患者。CAS与全因死亡率较高相关（调整后的风险比[HR]，1.282；95%置信区间[CI]，1.173 - 1.400）。CAS与CEA相比，缺血性中风复发和脑出血的调整率分别为24.9%对15.9%（HR，1.474；95%CI，1.325 - 1.639）和1.5%对0.9%（HR，2.026；95%CI，1.322 - 3.106）。在年轻有症状患者中，CAS和CEA在全因死亡率和心血管死亡方面无统计学显著差异。
我们利用韩国全国保险数据进行的研究结果与先前研究相似。在通过前瞻性研究确立CAS的进一步证据之前，应根据当前指南在选定患者中进行CAS。
