颈动脉内膜切除术闭合技术的长期耐久性和安全性。

Long-term Durability and Safety of Carotid Endarterectomy Closure Techniques.

机构信息

Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Greece.

Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varèse, Italy.

出版信息

World J Surg. 2020 Oct;44(10):3545-3554. doi: 10.1007/s00268-020-05604-0.

DOI:10.1007/s00268-020-05604-0

PMID:32462218

Abstract

BACKGROUND

Various techniques have been used for the execution of carotid endarterectomy; primary (PC), patch closure (CP) and eversion technique (ET).The superiority of any of them is still unproven. The aim of this study was to compare the long-term outcomes of each technique in terms of cerebrovascular event (CVE), restenosis, survival and major cardiac event (MACE).

METHODS

Between 2007 and 2018, a retrospective analysis of prospectively recorded data from three European tertiary centers was undertaken including 1.357 patients. Demographics, comorbidities and medical treatment were analyzed in relation to long-term outcomes. Freedom from CVE, restenosis (> 70%), survival and MACE were estimated with Kaplan-Meier analysis curve.

RESULTS

The mean age was 69.5 ± 8 (72% males;79% asymptomatic). 472 (35%) were treated with PC, 504 (37%) with CP and 381 (28%) with ET. Differences among groups were observed in age (P < 0.001), gender (P < 0.01), hypertension (P = 0.01), dyslipidemia (P < 0.001) and statin treatment (P < 0.001). The mean follow-up was 4.7 ± 3 years (median: 5 years). Seventy-three patients presented a CVE during 8 years of follow-up. The freedom from CVE including all techniques was 96% (SE 0.6%), 93% (SE 1%) and 89% (SE 1.6%), at 2, 5 and 8 years of follow-up, respectively, with no difference between groups (P .289). Freedom from restenosis was at 96% (SE 0.7%) and 89% (SE 5%) at 5 and 10 years, respectively, for all methods without differences. ET was associated with a higher mortality rate (P < 0.001) and MACE rate (P < 0.001).

CONCLUSIONS

Excellent outcomes were achieved with all types of closure techniques with low rates of MACE and other adverse events during long-term follow-up after CEA.

摘要

背景

颈动脉内膜切除术（CEA）的实施方法有多种，包括原发性（PC）、修补闭合（CP）和外翻技术（ET）。但这些方法的优越性仍未得到证实。本研究旨在比较每种技术在脑血管事件（CVE）、再狭窄、生存率和主要心脏事件（MACE）方面的长期结果。

方法

2007 年至 2018 年，对三个欧洲三级中心前瞻性记录数据进行回顾性分析，共纳入 1357 例患者。分析了人口统计学、合并症和药物治疗与长期结果的关系。通过 Kaplan-Meier 分析曲线估计 CVE 无复发率、再狭窄（>70%）、生存率和 MACE。

结果

平均年龄为 69.5±8 岁（72%为男性；79%为无症状）。472 例（35%）采用 PC 治疗，504 例（37%）采用 CP 治疗，381 例（28%）采用 ET 治疗。各组之间存在年龄（P<0.001）、性别（P<0.01）、高血压（P=0.01）、血脂异常（P<0.001）和他汀类药物治疗（P<0.001）的差异。平均随访时间为 4.7±3 年（中位数：5 年）。73 例患者在 8 年随访期间发生 CVE。所有技术的 CVE 无复发率分别为 96%（SE 0.6%）、93%（SE 1%）和 89%（SE 1.6%），在 2、5 和 8 年随访时，组间差异无统计学意义（P=0.289）。所有方法的再狭窄无复发率分别为 96%（SE 0.7%）和 89%（SE 5%），在 5 和 10 年时，组间差异无统计学意义。ET 与更高的死亡率（P<0.001）和 MACE 发生率（P<0.001）相关。