Yuan Wanzhong, Huo Ran, Ma Kaiming, Han Yunfeng, Yin Xiaoliang, Yang Jun, Zhao Xihai, Wang Tao
Department of Neurosurgery, Peking University Third Hospital, Beijing, China.
Department of Radiology, Peking University Third Hospital, Beijing, China.
Front Neurol. 2022 Aug 24;13:971673. doi: 10.3389/fneur.2022.971673. eCollection 2022.
To analyze the risk factors associated with adverse events after carotid endarterectomy (CEA) in patients with unilateral severe carotid stenosis and contralateral occlusion.
Patients were recruited for CEA between August 2014 and February 2020. CEA was performed under general anesthesia. The carotid clamp time (CCT; long CCT: >20 min) is defined as the period between clamp-on and clamp-off for the stenotic carotid artery. The perioperative factors and postoperative adverse events were recorded. All patients were followed up for 1 year after CEA.
Sixty subjects (65.8 ± 7.2 years; 54 males) were included. Patients with adverse events had significantly longer CCT than those without adverse events (60% vs. 40%, = 0.013). Univariate logistic regression analysis showed that a history of diabetes was significantly associated with adverse events (OR, 0.190; 95% CI, 0.045-0.814; = 0.025); long CCT was significantly associated with adverse events (OR, 8.500; 95% CI, 1.617-44.682; = 0.011). After adjusting for confounding factors, including age, sex, BMI, diabetes, PSV, long CCT, non-use of shunt, and history of stroke or TIA, the associations between diabetes and adverse events (OR, 0.113; 95% CI, 0.013-0.959; = 0.046) were statistically significant; the associations between long CCT and adverse events (OR, 1.301; 95% CI, 1.049-1.613; = 0.017) were statistically significant.
A longer carotid clamp time (>20 min) and a history of diabetes may increase the risk of adverse events in patients with unilateral severe carotid stenosis and contralateral occlusion after CEA. With good preoperative evaluation and intraoperative monitoring, the use of shunts may not be needed intraoperatively in patients with unilateral severe carotid stenosis and contralateral occlusion.
分析单侧严重颈动脉狭窄且对侧闭塞患者行颈动脉内膜切除术（CEA）后不良事件的相关危险因素。
选取2014年8月至2020年2月期间行CEA的患者。CEA在全身麻醉下进行。颈动脉夹闭时间（CCT；长CCT：>20分钟）定义为狭窄颈动脉夹闭至松开的时间段。记录围手术期因素和术后不良事件。所有患者在CEA后随访1年。
纳入60例受试者（65.8±7.2岁；54例男性）。发生不良事件的患者CCT显著长于未发生不良事件的患者（60%对40%，P = 0.013）。单因素逻辑回归分析显示，糖尿病史与不良事件显著相关（OR，0.190；95%CI，0.045 - 0.814；P = 0.025）；长CCT与不良事件显著相关（OR，8.500；95%CI，1.617 - 44.682；P = 0.011）。在调整包括年龄、性别、BMI、糖尿病、PSV、长CCT、未使用分流器以及卒中或短暂性脑缺血发作史等混杂因素后，糖尿病与不良事件之间的关联（OR，0.113；95%CI，0.013 - 0.959；P = 0.046）具有统计学意义；长CCT与不良事件之间的关联（OR，1.301；95%CI，1.049 - 1.613；P = 0.017）具有统计学意义。
较长的颈动脉夹闭时间（>20分钟）和糖尿病史可能增加单侧严重颈动脉狭窄且对侧闭塞患者行CEA后发生不良事件的风险。通过良好的术前评估和术中监测，单侧严重颈动脉狭窄且对侧闭塞的患者术中可能无需使用分流器。
