外翻式与传统颈动脉内膜切除术的长期疗效比较：一项多中心临床试验。
Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial.
机构信息
Petrovsky National Research Centre of Surgery, Moscow, Russia.
Alexander Clinic, St. Petersburg, Russia.
出版信息
Vascular. 2023 Aug;31(4):717-724. doi: 10.1177/17085381221084803. Epub 2022 Mar 24.
AIM
To compare the long-term results of eversion (ECEA) and conventional carotid endarterectomy (CCEA).
METHODS
We designed a retrospective, multicenter study which included 25,106 patients who underwent ECEA ( = 18,362) or CCEA ( = 6744). The duration of follow-up was 124.7 ± 53.8 months.
RESULTS
In the postoperative period, none of the interventions showed clear benefits reducing the frequency of complications: fatal outcome (ECEA: 0.19%, = 36; CCEA: 0.17%, = 12; OR = 1.1, 95% CI = 0.57-2.11, = 0.89), myocardial infarction (ECEA: 0.15%, = 28; CCEA: 0.13%, = 9; = 0.87; OR = 1.14; 95% CI = 0.53-2.42); acute cerebrovascular accident (CVA) (Group I: 0.33%, = 62; Group II: 0.4%, = 27; = 0.53; OR = 0.84; 95% CI = 0, 53-1.32); bleeding with acute haematoma appearance in the area of intervention (Group I: 0.39%, = 73; Group II: 0.41%, = 28; = 0.93; OR = 0.95; 95% CI = 0, 61-1.48); internal carotid artery (ICA) thrombosis (Group I: 0.05%, = 11; Group II: 0.07%, = 5; OR = 0.80, 95% CI = 0.28-2.32, = 0.90). During the long-term follow-up, ECEA was associated with lower frequency of fatal outcome (ECEA: 2.7%, = 492; CCEA: 9.1%, = 616; OR = 0.27; 95% CI = 0.24-0.3, < 0.0001), cerebrovascular death (ECEA: 1.0%, = 180; CCEA: 5.5%, = 371; OR = 0.17, 95% CI = 0.14-0.21, < 0.0001), non-fatal ischaemic stroke (ECEA: 0.62%, = 114; CCEA: 7.0%, = 472; OR = 0.08; 95% CI = 0.06-0.1, < 0.0001); repeated revascularization because of >60% restenosis (ECEA: 1.6%, = 296; CCEA: 12.6%, = 851; OR = 0.11, 95% CI = 0.09-0.12, < 0.0001), and combined endpoint (ECEA: 2.2%, = 397; CCEA: 13.2%, = 888; OR = 0.14; 95% CI = 0.12-1.16, < 0.0001).
CONCLUSION
ECEA is beneficial over CCEA in a long term.
目的
比较外翻（ECEA）和传统颈动脉内膜切除术（CCEA）的长期结果。
方法
我们设计了一项回顾性、多中心研究，纳入了 25106 名接受 ECEA（ = 18362）或 CCEA（ = 6744）的患者。随访时间为 124.7 ± 53.8 个月。
结果
在术后期间，两种干预措施均未显示出明显降低并发症发生率的优势：致命结局（ECEA：0.19%， = 36；CCEA：0.17%， = 12；OR = 1.1，95%CI = 0.57-2.11， = 0.89）、心肌梗死（ECEA：0.15%， = 28；CCEA：0.13%， = 9； = 0.87；OR = 1.14；95%CI = 0.53-2.42）；急性脑血管意外（CVA）（I 组：0.33%， = 62；II 组：0.4%， = 27； = 0.53；OR = 0.84；95%CI = 0，53-1.32）；在干预区域出现急性血肿外观的出血（I 组：0.39%， = 73；II 组：0.41%， = 28； = 0.93；OR = 0.95；95%CI = 0，61-1.48）；颈内动脉（ICA）血栓形成（I 组：0.05%， = 11；II 组：0.07%， = 5；OR = 0.80，95%CI = 0.28-2.32， = 0.90）。在长期随访中，ECEA 与较低的致命结局发生率相关（ECEA：2.7%， = 492；CCEA：9.1%， = 616；OR = 0.27；95%CI = 0.24-0.3， < 0.0001）、脑血管死亡（ECEA：1.0%， = 180；CCEA：5.5%， = 371；OR = 0.17，95%CI = 0.14-0.21， < 0.0001）、非致命性缺血性中风（ECEA：0.62%， = 114；CCEA：7.0%， = 472；OR = 0.08；95%CI = 0.06-0.1， < 0.0001）；由于 >60%的再狭窄而再次血运重建（ECEA：1.6%， = 296；CCEA：12.6%， = 851；OR = 0.11，95%CI = 0.09-0.12， < 0.0001）和复合终点（ECEA：2.2%， = 397；CCEA：13.2%， = 888；OR = 0.14；95%CI = 0.12-1.16， < 0.0001）。
结论
ECEA 在长期随访中优于 CCEA。
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