Qumsiyeh Yazen, Siada Sammy, Yan Yueqi, Dirks Rachel, Ali Amna, Daneshvar Meelod, O'Banion Leigh Ann
Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA.
Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA.
J Vasc Surg. 2023 Jan;77(1):176-181. doi: 10.1016/j.jvs.2022.07.169. Epub 2022 Aug 6.
Carotid endarterectomy (CEA) has demonstrated superior results in stroke risk reduction for patients with symptomatic and asymptomatic high-grade carotid stenosis. However, this benefit has long been questioned for the elderly and high-risk populations. In the present study, we aimed to provide high-volume, single-institution data with long-term follow-up examining the risk factors for postoperative stroke and stroke-free survival stratified by age for asymptomatic and symptomatic patients undergoing CEA.
A single-institution retrospective review of 840 consecutive patients who had undergone CEA from 2011 to 2018 was performed, inclusive of both symptomatic and asymptomatic operative indications. The primary end point was perioperative stroke within 30 days of surgery. The secondary end points were late stroke, death, and myocardial infarction. Patients aged >80 years were compared with those aged <80 years to examine freedom from stroke and death. Statistically significant differences were defined as those with P < .05.
A total of 840 patients were evaluated with a median follow-up of 416 ± 1244 days. Of the 840 patients, 499 (59%) were men, and 604 (72%) were White. The mean age was 72 ± 9 years, with 202 (24%) aged ≥80 years. CEA was performed for symptomatic disease in 305 patients (36%), of whom 143 (47%) had had strokes and 162 (53%) had had transient ischemic attacks. The overall 30-day postoperative stroke rate was 1.0% (eight patients; 0.6% for asymptomatic and 1.6% for symptomatic; P = .147). Compared with younger patients, octogenarians had had a similar stroke rate after CEA (1.5% vs 0.8%; P = .407). Hispanic race was an independent risk factor for postoperative stroke. White race and preoperative statin use both appeared to be protective. Kaplan-Meier survival curves demonstrated decreased a 5-year stroke-free survival in patients aged ≥80 years (P = .031). However, overall, the estimated 5-year survival was similar to the U.S. general population across both age groups.
CEA for octogenarians is safe and effective for both symptomatic and asymptomatic populations with excellent 30-day outcomes and long-term survival mirroring that of the general population.
对于有症状和无症状的重度颈动脉狭窄患者，颈动脉内膜切除术（CEA）在降低中风风险方面已显示出卓越的效果。然而，对于老年和高危人群，这种益处长期以来一直受到质疑。在本研究中，我们旨在提供来自单一机构的大量数据，并进行长期随访，以研究接受CEA的无症状和有症状患者术后中风的危险因素以及按年龄分层的无中风生存期。
对2011年至2018年连续接受CEA的840例患者进行了单一机构的回顾性研究，纳入了有症状和无症状的手术指征。主要终点是术后30天内的围手术期中风。次要终点是迟发性中风、死亡和心肌梗死。将年龄>80岁的患者与年龄<80岁的患者进行比较，以检查无中风和死亡情况。统计学上的显著差异定义为P <.05。
共评估了840例患者，中位随访时间为416±1244天。在这840例患者中，499例（59%）为男性，604例（72%）为白人。平均年龄为72±9岁，其中202例（24%）年龄≥80岁。305例患者（36%）因有症状疾病接受了CEA，其中143例（47%）曾发生过中风，162例（53%）曾发生过短暂性脑缺血发作。术后30天的总体中风率为1.0%（8例患者；无症状患者为0.6%，有症状患者为1.6%；P =.147）。与年轻患者相比，80岁以上患者CEA后的中风率相似（1.5%对0.8%；P =.407）。西班牙裔种族是术后中风的独立危险因素。白人种族和术前使用他汀类药物似乎都具有保护作用。Kaplan-Meier生存曲线显示，年龄≥80岁的患者5年无中风生存期降低（P =.031）。然而，总体而言，两个年龄组的估计5年生存率与美国普通人群相似。
对于80岁以上患者，CEA对有症状和无症状人群均安全有效，30天预后良好，长期生存率与普通人群相当。
