Mihály Zsuzsanna, Booth Samuel, Nguyen Dat Tin, Vecsey-Nagy Milán, Vértes Miklós, Czinege Zsófia, Péter Csongor, Sótonyi Péter, Varga Andrea
Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary.
Department of Cardiology, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary.
J Cardiovasc Dev Dis. 2023 Jun 13;10(6):257. doi: 10.3390/jcdd10060257.
(1) Study purpose: The aim of our prospective single-center, matched case-control study was to compare the number and volume of acute ischemic brain lesions following carotid endarterectomy (CEA) versus carotid artery stenting (CAS) using a propensity-matched design. (2) Methods: Carotid bifurcation plaques were analyzed by using VascuCAP software on CT angiography (CTA) images. The number and volume of acute and chronic ischemic brain lesions were assessed on MRI scans taken 12-48 h after the procedures. Propensity score-based matching was performed at a 1:1 ratio to compare the ischemic lesions on postinterventional MR. (3) Results: A total of 107 patients (CAS, = 33; CEA, = 74) were included in the study. There were significant differences in smoking ( = 0.003), total calcification plaque volume ( = 0.004), and lengths of the lesion ( = 0.045) between the CAS and CEA groups. Propensity score matching resulted in 21 matched pairs of patients. Acute ischemic brain lesions were detected in ten patients (47.6%) of the matched CAS group and in three patients (14.2%) in the matched CEA group ( = 0.02). The volume of acute ischemic brain lesions was significantly larger ( = 0.04) in the CAS group than in the CEA group. New ischemic brain lesions were not associated with neurological symptoms in either group. (4) Conclusions: Procedure-related new acute ischemic brain lesions occurred significantly more frequently in the propensity-matched CAS group.
(1) 研究目的：我们这项前瞻性单中心、匹配病例对照研究的目的是采用倾向匹配设计，比较颈动脉内膜切除术（CEA）与颈动脉支架置入术（CAS）后急性缺血性脑损伤的数量和体积。(2) 方法：利用VascuCAP软件对CT血管造影（CTA）图像上的颈动脉分叉斑块进行分析。在术后12 - 48小时所做的MRI扫描上评估急性和慢性缺血性脑损伤的数量和体积。基于倾向评分进行1:1比例的匹配，以比较介入后MRI上的缺血性损伤。(3) 结果：共有107例患者（CAS组33例，CEA组74例）纳入研究。CAS组和CEA组在吸烟情况（P = 0.003）、钙化斑块总体积（P = 0.004）和病变长度（P = 0.045）方面存在显著差异。倾向评分匹配产生了21对匹配患者。在匹配的CAS组中，10例患者（47.6%）检测到急性缺血性脑损伤，在匹配的CEA组中有3例患者（14.2%）检测到（P = 0.02）。CAS组急性缺血性脑损伤的体积显著大于CEA组（P = 0.04）。两组中，新的缺血性脑损伤均与神经症状无关。(4) 结论：在倾向匹配的CAS组中，与手术相关的新急性缺血性脑损伤发生频率显著更高。
