标准术前影像学报告中的脑小血管疾病与颈动脉内膜切除术（CEA）后心血管死亡风险增加独立相关。
Cerebral Small Vessel Disease in Standard Pre-operative Imaging Reports Is Independently Associated with Increased Risk of Cardiovascular Death Following Carotid Endarterectomy.
机构信息
Department of Vascular Surgery, Division of Surgical Specialties, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
Laboratory of Clinical Chemistry and Haematology, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
出版信息
Eur J Vasc Endovasc Surg. 2020 Jun;59(6):872-880. doi: 10.1016/j.ejvs.2020.02.004. Epub 2020 Apr 21.
OBJECTIVE
Cerebral white matter lesions (WMLs) and lacunar infarcts are surrogates of cerebral small vessel disease (SVD). WML severity as determined by trained radiologists predicts post-operative stroke or death in patients undergoing carotid endarterectomy (CEA). It is unknown whether routine pre-operative brain imaging reports as part of standard clinical practice also predict short and long term risk of stroke and death after CEA.
METHODS
Consecutive patients from the Athero-Express biobank study that underwent CEA for symptomatic high degree stenosis between March 2002 and November 2014 were included. Pre-operative brain imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) reports were reviewed for reporting of SVD, defined as WMLs or any lacunar infarcts. The primary outcome was defined as any stroke or any cardiovascular death over three year follow up. The secondary outcome was defined as the 30 day peri-operative risk of stroke or cardiovascular death.
RESULTS
A total of 1038 patients were included (34% women), of whom 659 (63.5%) had CT images and 379 (36.5%) MRI images available. Of all patients, 697 (67%) had SVD reported by radiologists. Patients with SVD had a higher three year risk of cardiovascular death than those without (6.5% vs. 2.1%, adjusted HR 2.52 [95% CI 1.12-5.67]; p = .026) but no association was observed for the three year risk of stroke (9.0% vs. 6.7%, for patients with SVD vs. those without, adjusted HR 1.24 [95% CI 0.76-2.02]; p = .395). No differences in 30 day peri-operative risk were observed for stroke (4.4% vs. 2.9%, for patients with vs. those without SVD; adjusted HR 1.49 [95% CI 0.73-3.05]; p = .28), and for the combined stroke/cardiovascular death risk (4.4% vs. 3.5%, adjusted HR 1.20 [95% CI 0.61-2.35]; p = .59).
CONCLUSION
Presence of SVD in pre-operative brain imaging reports can serve as a predictor for the three year risk of cardiovascular death in symptomatic patients undergoing CEA but does not predict peri-operative or long term risk of stroke.
目的
脑白质病变（WML）和腔隙性梗死是脑小血管疾病（SVD）的替代标志物。经过训练的放射科医生确定的 WML 严重程度可预测颈动脉内膜切除术（CEA）后患者的术后中风或死亡。尚不清楚作为标准临床实践一部分的常规术前脑影像报告是否也可预测 CEA 后短期和长期的中风和死亡风险。
方法
纳入 2002 年 3 月至 2014 年 11 月期间因症状性高程度狭窄而行 CEA 的 Athero-Express 生物库研究中的连续患者。回顾术前脑成像（计算机断层扫描[CT]或磁共振成像[MRI]）报告，以报告 SVD，定义为 WML 或任何腔隙性梗死。主要结局定义为 3 年随访期间的任何中风或任何心血管死亡。次要结局定义为围手术期 30 天内的中风或心血管死亡风险。
结果
共纳入 1038 例患者（34%为女性），其中 659 例（63.5%）有 CT 图像，379 例（36.5%）有 MRI 图像。所有患者中，697 例（67%）有放射科医生报告的 SVD。有 SVD 的患者 3 年心血管死亡风险高于无 SVD 的患者（6.5%比 2.1%，调整后的 HR 2.52[95%CI 1.12-5.67]；p=0.026），但 3 年中风风险无关联（SVD 患者为 9.0%，无 SVD 患者为 6.7%，调整后的 HR 1.24[95%CI 0.76-2.02]；p=0.395）。在 30 天围手术期内，中风风险无差异（有 SVD 的患者为 4.4%，无 SVD 的患者为 2.9%；调整后的 HR 1.49[95%CI 0.73-3.05]；p=0.28），中风/心血管死亡风险也无差异（有 SVD 的患者为 4.4%，无 SVD 的患者为 3.5%，调整后的 HR 1.20[95%CI 0.61-2.35]；p=0.59）。
结论
术前脑影像报告中存在 SVD 可作为症状性 CEA 患者 3 年心血管死亡风险的预测指标，但不能预测围手术期或长期的中风风险。
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