Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA.
Vasc Endovascular Surg. 2024 Apr;58(3):280-286. doi: 10.1177/15385744231207015. Epub 2023 Oct 18.
Perioperative stroke is the most dreaded complication of carotid artery interventions and can severely affect patients' quality of life. This study evaluated the impact of this event on mortality for patients undergoing interventional treatment of carotid artery stenosis with three different modalities.
Patients undergoing carotid revascularization at participating Memorial Hermann Health System facilities were captured from 2003-2022. These patients were treated with either carotid endarterectomy (CEA), transfemoral carotid stenting (TF-CAS), or transcarotid artery revascularization (TCAR). Perioperative outcomes, including stroke and mortality, as well as follow-up survival data at 6-month intervals, were analyzed and stratified per treatment modality.
Of the 1681 carotid revascularization patients identified, 992 underwent CEA (59.0%), 524 underwent TCAR (31.2%), and 165 underwent TF-CAS (9.8%). The incidence of stroke was 2.1% (CEA 2.1%, TCAR 1.7%, and TF-CAS 3.6%; = .326). The perioperative (30-day) death rate was 2.1% (n = 36). The perioperative death rate was higher in patients who suffered from an intraoperative stroke than in those who did not (8.3% vs 1.9%, = .007). Perioperative death was also different between CEA, TCAR, and TF-CAS for patients who had an intraoperative stroke (.0% vs 33.3% vs .0%, = .05). TCAR patients were likely to be older ( < .001), have a higher body mass index ( < .001), and have diabetes mellitus ( < .001). Patients who suffered from an intraoperative stroke were more likely to have a symptomatic carotid lesion (58.3% vs 28.8%, < .001). The TCAR group had a significantly lower survival at 6 months and 12 months when compared to the other two groups (64.9% vs 100% = .007).
Perioperative stroke during carotid interventions significantly impacts early patient survival with otherwise no apparent change in mid-term outcomes at 5 years. This difference appears to be even more significant in patients undergoing TCAR, possibly due to their baseline higher-risk profile and lower functional reserve.
围手术期卒中是颈动脉介入治疗最可怕的并发症，可严重影响患者的生活质量。本研究评估了三种不同方法治疗颈动脉狭窄的介入治疗患者发生该事件对死亡率的影响。
从 2003 年至 2022 年，在参与 Memorial Hermann 健康系统设施的患者中捕获接受颈动脉血运重建的患者。这些患者接受颈动脉内膜切除术（CEA）、股动脉颈动脉支架置入术（TF-CAS）或经颈动脉血运重建术（TCAR）治疗。分析和分层了围手术期结果，包括卒中发生率和死亡率，以及每 6 个月随访的生存数据。
在 1681 名接受颈动脉血运重建的患者中，992 名接受 CEA（59.0%），524 名接受 TCAE（31.2%），165 名接受 TF-CAS（9.8%）。卒中发生率为 2.1%（CEA 2.1%，TCAR 1.7%，TF-CAS 3.6%； =.326）。围手术期（30 天）死亡率为 2.1%（n = 36）。术中发生卒中的患者围手术期死亡率高于未发生卒中的患者（8.3%比 1.9%， =.007）。对于术中发生卒中的患者，CEA、TCAR 和 TF-CAS 之间的围手术期死亡率也不同（0.0%比 33.3%比 0.0%， =.05）。TCAR 患者更可能年龄较大（<.001）、体重指数较高（<.001）且患有糖尿病（<.001）。术中发生卒中的患者更可能有症状性颈动脉病变（58.3%比 28.8%，<.001）。与其他两组相比，TCAR 组在 6 个月和 12 个月时的生存率明显较低（64.9%比 100%， =.007）。
颈动脉介入治疗期间发生围手术期卒中显著影响早期患者生存率，而在 5 年时中期结局无明显变化。在接受 TCAR 的患者中，这种差异似乎更为明显，可能是由于他们的基线高风险特征和较低的功能储备。
