Knappich Christoph, Bohmann Bianca, Kirchhoff Felix, Lohe Vanessa, Naher Shamsun, Kallmayer Michael, Eckstein Hans-Henning, Kuehnl Andreas
Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Ann Surg. 2025 Jul 1;282(1):154-162. doi: 10.1097/SLA.0000000000006284. Epub 2024 Mar 28.
This study aimed at assessing outcomes after carotid endarterectomy (CEA) in dependence of center policy with respect to imaging intraoperative completion study (ICS i ) usage.
Although randomized controlled studies are missing, a beneficial effect was shown for ICS i techniques (ie, angiography and intraoperative duplex ultrasound) after CEA.
This secondary data analysis is based on the German statutory quality assurance database. The research was funded by Germany's Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their ICS i policy, hospitals were categorized as routine ICS i (>90%), selective ICS i (10%-90%), or sporadic ICS i (<10%) centers. Primary study outcome was in-hospital stroke or death. Multivariable regression analyses were performed.
Between 2012 and 2016, a total of 119,800 patients underwent CEA. In-hospital stroke or death rates were lower in routine ICS i centers (1.7%) compared with selective (2.1%) and sporadic ICS i centers (2.0%). The multivariable regression analysis showed, that in routine ICS i centers, ICS i use was associated with lower rates of stroke or death (adjusted odds ratio: 0.64; 95% CI: 0.44-0.93). In selective ICS i centers, ICS i was not associated with the occurrence of either of the assessed outcomes. In sporadic ICS i centers, ICS i was associated with higher rates of stroke or death (adjusted odds ratio: 1.91; 95% CI: 1.26-2.91).
Lowest in-hospital stroke or death rates are achieved in routine ICS i centers. Although ICS i is associated with a lower perioperative risk in routine ICS i centers, it might act as a surrogate marker for worse outcomes due to intraoperative irregularities in sporadic ICS i centers. Routine use of ICS i is advisable.
本研究旨在根据中心关于术中成像完成研究（ICS i）使用的政策，评估颈动脉内膜切除术（CEA）后的结果。
尽管缺乏随机对照研究，但CEA术后ICS i技术（即血管造影和术中双功超声）显示出有益效果。
这项二次数据分析基于德国法定质量保证数据库。该研究由德国联邦联合委员会创新基金（G-BA Innovationsfonds，01VSF19016 ISAR-IQ）资助。根据其ICS i政策，医院被分为常规ICS i（>90%）、选择性ICS i（10%-90%）或偶发性ICS i（<10%）中心。主要研究结果是住院期间发生卒中或死亡。进行了多变量回归分析。
2012年至2016年期间，共有119,800例患者接受了CEA。常规ICS i中心的住院期间卒中或死亡率（1.7%）低于选择性（2.1%）和偶发性ICS i中心（2.0%）。多变量回归分析显示，在常规ICS i中心，使用ICS i与较低的卒中或死亡率相关（调整优势比：0.64；95%置信区间：0.44-0.93）。在选择性ICS i中心，ICS i与所评估的任何结果的发生均无关联。在偶发性ICS i中心，ICS i与较高的卒中或死亡率相关（调整优势比：1.91；95%置信区间：1.26-2.91）。
常规ICS i中心的住院期间卒中或死亡率最低。尽管ICS i在常规ICS i中心与较低的围手术期风险相关，但在偶发性ICS i中心，由于术中出现异常情况，它可能是预后较差的替代指标。建议常规使用ICS i。
