Department of Neurosurgery, Yokohama Brain and Spine Center, 1-2-1, Takigashira, Isogo, Yokohama, Kanagawa, 2350012, Japan.
Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 2360004, Japan.
J Stroke Cerebrovasc Dis. 2022 Mar;31(3):106269. doi: 10.1016/j.jstrokecerebrovasdis.2021.106269. Epub 2021 Dec 25.
Through the progression of devices, the adaptation of carotid artery stenting (CAS) has been expanded according to the non-inferiority of CAS for carotid endarterectomy reported by several randomized control trials. To maintain favorable outcomes, identifying prognostic factors is essential for optimizing treatment indications and periprocedural management. This study focused on the prognostic factors of CAS using real-world data.
This retrospective multicenter cohort study aimed to identify the prognostic factors after CAS using real-world data from the stroke registry of Yokohama (STrOke Registry of Yokohama; STORY) from January 1, 2018 to May 31, 2021. Patient characteristics, procedural factors, complications, and prognoses were collected using medical records.
Data from 107 patients were enrolled in this study after excluding those with insufficient data (2 cases). The mean participant age was 74.9±8.2 years, and 66 patients (61.7%) were symptomatic. Symptomatic lesions were a significant prognostic factor in the overall analysis (p=0.003). A multivariate analysis showed that the estimated glomerular filtration rate (eGFR) (odds ratio: 1.11, p=0.003) and staged CAS (odds ratio: 38.9, p=0.04) were independent prognostic factors. The odds ratio and relative risk of mRS deterioration when eGFR was under 49 mL/min/1.73 m compared with when eGFR was above 49 mL/min/1.73 m were 5.2 and 3.74, respectively.
In this real-world multicenter study, we established independent prognostic factors for CAS using high totality data. For patients with symptomatic lesions and low eGFR (≤49 mL/min/1.73 m), indication for treatment should be considered strictly.
随着器械的进步，根据几项随机对照试验报道的颈动脉支架置入术（CAS）与颈动脉内膜切除术的非劣效性，CAS 的适应证不断扩大。为了保持良好的结果，确定预后因素对于优化治疗适应证和围手术期管理至关重要。本研究旨在使用真实世界数据探讨 CAS 的预后因素。
本回顾性多中心队列研究使用 2018 年 1 月 1 日至 2021 年 5 月 31 日横浜卒中登记（STrOke Registry of Yokohama；STORY）中的真实世界数据，旨在确定 CAS 后的预后因素。使用病历收集患者特征、手术因素、并发症和预后。
在排除数据不足的 2 例患者后，本研究共纳入 107 例患者。患者平均年龄为 74.9±8.2 岁，66 例（61.7%）为症状性病变。症状性病变是总分析中的显著预后因素（p=0.003）。多变量分析显示，估算肾小球滤过率（eGFR）（比值比：1.11，p=0.003）和分期 CAS（比值比：38.9，p=0.04）是独立的预后因素。与 eGFR 大于 49 mL/min/1.73 m 相比，eGFR 小于等于 49 mL/min/1.73 m 时 mRS 恶化的比值比和相对风险分别为 5.2 和 3.74。
在这项真实世界的多中心研究中，我们使用高总体数据确定了 CAS 的独立预后因素。对于有症状病变和低 eGFR（≤49 mL/min/1.73 m）的患者，应严格考虑治疗适应证。
