同侧颈动脉内膜切除术和对侧颈动脉支架置入术后患者的再狭窄率。
Restenosis rates in patients with ipsilateral carotid endarterectomy and contralateral carotid artery stenting.
机构信息
Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Hungarian Vascular Radiology Research Group, Budapest, Hungary.
出版信息
PLoS One. 2022 Feb 11;17(2):e0262735. doi: 10.1371/journal.pone.0262735. eCollection 2022.
PURPOSE
We aimed to evaluate the long-term outcome of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in patients who underwent both procedures on different sides.
METHODS
In this single-center retrospective study (2001-2019), 117 patients (men, N = 78; median age at CEA, 64.4 [interquartile range {IQR}, 57.8-72.2] years; median age at CAS, 68.8 [IQR, 61.0-76.0] years) with ≥50% internal carotid artery stenosis who had CEA on one side and CAS on the other side were included. The risk of restenosis was estimated by treatment adjusted for patient and lesion characteristics.
RESULTS
Neurological symptoms were significantly more common (41.9% vs 16.2%, P<0.001) and patients had a significantly shorter mean duration of smoking (30.2 [standard deviation {SD}, 22.2] years vs 31.8 [SD, 23.4] years, P<0.001), hypertension (10.1 [SD, 9.8] years vs 13.4 [SD, 9.1] years, P<0.001), hyperlipidemia (3.6 [SD, 6.6] years vs 5.0 [SD, 7.3] years, P = 0.001), and diabetes mellitus (3.9 [SD, 6.9] years vs 5.7 [SD, 8.9] years, P<0.001) before CEA compared to those before CAS. While the prevalence of heavily calcified stenoses on the operated side (25.6% vs 6.8%, P<0.001), the incidence of predominantly echogenic/echogenic plaques (53.0% vs 70.1%, P = 0.011) and suprabulbar lesions (1.7% vs 22.2%, P<0.001) on the stented side was significantly higher. Restenosis rates were 10.4% at 1 year, 22.3% at 5 years, and 33.7% at the end of the follow-up (at 11 years) for CEA, while these were 11.4%, 14.7%, and 17.2%, respectively, for CAS. Cox regression analysis revealed a significantly higher risk of restenosis (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.05-3.10; P = 0.030) for CEA compared to that for CAS. After adjusting for relevant confounding factors (smoking, hypertension, diabetes mellitus, calcification severity, plaque echogenicity, and lesion location), the estimate effect size materially did not change, although it did not remain statistically significant (HR, 1.85; 95% CI, 0.95-3.60; P = 0.070).
CONCLUSION
Intra-patient comparison of CEA and CAS in terms of restenosis tilts the balance toward CAS.
目的
我们旨在评估在不同侧接受颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）的患者的长期结果。
方法
在这项单中心回顾性研究（2001-2019 年）中，纳入了 117 名（男性，N=78；CEA 时的中位年龄，64.4[四分位距{IQR}，57.8-72.2]岁；CAS 时的中位年龄，68.8[IQR，61.0-76.0]岁）存在≥50%颈内动脉狭窄并在一侧接受 CEA 另一侧接受 CAS 的患者。通过针对患者和病变特征的治疗调整来估计再狭窄风险。
结果
神经症状明显更常见（41.9%比 16.2%，P<0.001），并且患者的平均吸烟时间明显缩短（30.2[标准差{SD}，22.2]年比 31.8[SD，23.4]年，P<0.001）、高血压（10.1[SD，9.8]年比 13.4[SD，9.1]年，P<0.001）、高脂血症（3.6[SD，6.6]年比 5.0[SD，7.3]年，P=0.001）和糖尿病（3.9[SD，6.9]年比 5.7[SD，8.9]年，P<0.001）。与 CAS 前相比，CEA 侧严重钙化狭窄的患病率更高（25.6%比 6.8%，P<0.001），而主要为回声增强/回声斑块（53.0%比 70.1%，P=0.011）和球部病变（1.7%比 22.2%，P<0.001）的发生率在支架侧明显更高。CEA 的 1 年、5 年和随访结束时（11 年）的再狭窄率分别为 10.4%、22.3%和 33.7%，而 CAS 的相应再狭窄率分别为 11.4%、14.7%和 17.2%。Cox 回归分析显示，与 CAS 相比，CEA 的再狭窄风险显著更高（风险比[HR]，1.80；95%置信区间[CI]，1.05-3.10；P=0.030）。在调整了相关混杂因素（吸烟、高血压、糖尿病、钙化严重程度、斑块回声和病变位置）后，尽管估计的效应大小没有明显变化，但它不再具有统计学意义（HR，1.85；95%CI，0.95-3.60；P=0.070）。
结论
从再狭窄的角度来看，在同一患者中对 CEA 和 CAS 进行比较，天平倾向于 CAS。
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