Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105594. doi: 10.1016/j.jstrokecerebrovasdis.2020.105594. Epub 2021 Jan 8.
The ongoing literature recommends carotid endarterectomy (CEA) primarily for patients with neurological symptoms, however CEA can be precluded by the onset of a severe stroke or a total carotid occlusion. The present study aims to evaluate the effect of unheralded strokes in patients with a previously asymptomatic carotid stenosis (ACS) possibly considered for CEA.
From 2009 to 2019, patients with an unheralded stroke from an ACS were considered. By neurological examination, patients were divided in unfit-for-CEA (uCEA) - either for the severity of the stroke (according to modified Rankin-Scale - mRS) or the onset of a total carotid occlusion - and patients submitted to CEA. Predictors for uCEA and stroke severity were evaluated.
Over a total of 532 patients with symptomatic carotid stenosis, 277 (52%) with unheralded stroke were included in the study. One hundred and one (36%) were considered uCEA: 64(23%) due to their neurological conditions (mRS:5) and 37 (13%) because of the onset of carotid occlusion. One hundred seventy-six (64%) patients underwent CEA. The preoperative medical therapy was similar in uCEA vs CEA patients. Age≥80 years and female sex were independently associated with uCEA (OR:5.9, 95%CI:3.1-11.4, P<.01; OR:3.9, 95%CI:2.0-7.6, P<.01. respectively). Patients submitted to CEA had mRS: 0-2 in 102(37%) cases and mRS:3-4 in 74 (27%). The contralateral carotid occlusion (CCO) was independently associated with mRS:3-4 (OR:8.4, 95%CI 1.8-79, P=.01). Postoperative stroke rate after CEA was 2.9% (4/167); patients with preoperative mRS:3-4 had a higher risk for postoperative stroke compared to those with mRS:0-2 (5.9% vs. 0%. P=.02).
An unheralded stroke in patients with ACS leads to a severe neurological damage in more than half of cases, either precluding CEA (36%) or increasing the risk of postoperative complications (27%). Female sex, age≥80 and CCO are independent predictors of these occurrences and should be considered in ACS patients.
目前的文献建议颈动脉内膜切除术（CEA）主要用于有神经症状的患者，但由于严重中风或颈动脉完全闭塞，CEA 可能会被排除在外。本研究旨在评估先前无症状颈动脉狭窄（ACS）患者中突发的无症状性中风对可能考虑 CEA 的患者的影响。
2009 年至 2019 年，研究考虑了 ACS 突发的无症状性中风患者。通过神经检查，患者分为不适合 CEA（uCEA）-要么是因为中风的严重程度（根据改良 Rankin 量表-mRS），要么是因为颈动脉完全闭塞-和接受 CEA 的患者。评估了 uCEA 和中风严重程度的预测因素。
在总共 532 名有症状颈动脉狭窄的患者中，277 名（52%）患有无症状性中风的患者被纳入研究。101 名（36%）被认为是 uCEA：64 名（23%）是由于他们的神经状况（mRS：5），37 名（13%）是由于颈动脉闭塞的发生。176 名（64%）患者接受了 CEA。uCEA 与 CEA 患者的术前药物治疗相似。年龄≥80 岁和女性是与 uCEA 独立相关的因素（OR：5.9，95%CI：3.1-11.4，P<.01；OR：3.9，95%CI：2.0-7.6，P<.01）。接受 CEA 的患者 mRS 为 0-2 的有 102 例（37%），mRS 为 3-4 的有 74 例（27%）。对侧颈动脉闭塞（CCO）与 mRS：3-4 独立相关（OR：8.4，95%CI 1.8-79，P=.01）。CEA 后的术后中风率为 2.9%（4/167）；术前 mRS 为 3-4 的患者术后中风的风险高于 mRS 为 0-2 的患者（5.9%比 0%，P=.02）。
ACS 患者的无症状性中风导致超过一半的患者出现严重的神经损伤，要么排除 CEA（36%），要么增加术后并发症的风险（27%）。女性、年龄≥80 岁和 CCO 是这些情况的独立预测因素，应在 ACS 患者中考虑。
