Deser Serkan Burç, Demirağ Mustafa Kemal, Kolbakır Fersat
Department of Cardiovascular Surgery, Medicine Faculty of Ondokuz Mayıs University, Samsun, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Jan 1;27(1):35-42. doi: 10.5606/tgkdc.dergisi.2019.15878. eCollection 2019 Jan.
This study aims to evaluate the effect of contralateral internal carotid artery stenosis on postoperative stroke and mortality rate and blood pressure alterations following carotid artery endarterectomy.
Between January 2009 and April 2017, a total of 152 carotid artery endarterectomy operations in 141 consecutive patients (30 females, 111 males; mean age 70.0±10.2 years; range, 48 to 92 years) with internal carotid artery stenosis were retrospectively analyzed. The patients were divided into two groups as those with contralateral internal carotid artery stenosis <70% (n=95) and contralateral internal carotid artery stenosis ?70% (n=26). Stroke and mortality rates in the early postoperative period (within the first 30 days), postoperative blood pressure alterations at six and 24 hours, non-neurological outcomes, and baseline demographic characteristics were analyzed and compared between the groups.
Both groups showed similar results in terms of the demographic characteristics. There was no statistically significant difference in the postoperative blood pressure alterations at six (p=0.917) and 24 hours (p=0.6), stroke rate (7.6% vs. 3.1%, p=0.282), mortality rate (3.8% vs. 2.1%, p=0.519), non-neurological complications (15.3% vs. 11.4%, p=0.736), and length of hospital stay (p>0.05) between the groups. The patients with contralateral severe internal carotid artery stenosis were younger (p=0.005).
The present study shows that the presence of a contralateral severe internal carotid artery stenosis does not increase the risk of postoperative stroke and mortality rates and blood pressure alterations. Therefore, carotid artery endarterectomy can be performed with acceptable complication rates in patients with contralateral severe internal carotid artery stenosis with strict perioperative hemodynamic monitoring.
本研究旨在评估对侧颈内动脉狭窄对颈动脉内膜剥脱术后中风、死亡率及血压变化的影响。
回顾性分析2009年1月至2017年4月期间，141例连续的颈内动脉狭窄患者（30例女性，111例男性；平均年龄70.0±10.2岁；范围48至92岁）所进行的152例颈动脉内膜剥脱术。患者被分为两组，即对侧颈内动脉狭窄<70%的患者（n = 95）和对侧颈内动脉狭窄≥70%的患者（n = 26）。分析并比较两组患者术后早期（术后30天内）的中风和死亡率、术后6小时和24小时的血压变化、非神经学结局以及基线人口统计学特征。
两组在人口统计学特征方面显示出相似的结果。两组之间在术后6小时（p = 0.917）和24小时（p = 0.6）的血压变化、中风率（7.6%对3.1%，p = 0.282）、死亡率（3.8%对2.1%，p = 0.519）、非神经学并发症（15.3%对11.4%，p = 0.736）以及住院时间（p>0.05）方面均无统计学显著差异。对侧颈内动脉严重狭窄的患者更年轻（p = 0.005）。
本研究表明，对侧颈内动脉严重狭窄的存在并不会增加术后中风、死亡率及血压变化的风险。因此，在严格的围手术期血流动力学监测下，对侧颈内动脉严重狭窄的患者可进行颈动脉内膜剥脱术，且并发症发生率可接受。
