Polania-Sandoval Camilo, Meschia James F, Huang Josephine, Esquetini-Vernon Camila, Barrett Kevin M, Fox W Christopher, Miller David A, Chen Xindi, Jacobs Christopher, Huynh Thien, Beegle Richard D, Tawk Rabih, Sandhu Sukhwinder J S, Farres Houssam, Erben Young
Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL.
Department of Neurology, Mayo Clinic, Jacksonville, FL.
Ann Vasc Surg. 2025 Sep;118:104-112. doi: 10.1016/j.avsg.2025.04.124. Epub 2025 May 2.
Symptomatic carotid artery stenosis requires timely intervention to reduce risk of recurrent stroke. However, the optimal timing of revascularization remains debated. This study evaluates outcomes in patients undergoing urgent (<48 hr), early (3-14 days), or delayed (>14 days) carotid artery revascularization.
This retrospective cohort study included 186 interventions in symptomatic patients categorized by timing of intervention defined as urgent (<48 hr from symptom onset, n = 47), early (3-14 days, n = 90), and delayed (>14 days, n = 49). Baseline characteristics, procedural details, and outcomes were analyzed. Outcome measures included perioperative stroke, transient ischemic attack (TIA), myocardial infarction, and mortality at 30 days and on follow-up.
The cohort's mean age was 71.3 ± 9.6 years, with no difference among groups, and with a balanced sex distribution (P = 0.75). Comorbidities included hypertension, hyperlipidemia, and chronic kidney disease, which were similar across groups (P > 0.05). National Institutes of Health stroke scale on admission was significantly different between groups (urgent: 4.7 ± 4.6; early: 8.2 ± 8.1; delayed: 4.0 ± 5.2; P = 0.01). The level of disability measured through the modified Rankin scale at discharge demonstrated no significant difference between groups (urgent: 0.9 ± 1.3; early: 1.1 ± 1.3; delayed: 0.5 ± 1.0; P = 0.09). At 30 days, ipsilateral strokes/TIA occurred in 3 (6.4%) patients in the urgent group, and none in either the early group or delayed group (P = 0.02). Thirty-day mortality was observed in 2 (4.3%) patients in the urgent group and 1 (1.1%) in the early group (P = 0.23). The 30-day composite of stroke, TIA, myocardial infarction, or death was significantly higher in the urgent group (urgent: 8.5%, early: 1.1%, delayed: 0.0%; P = 0.02). At a mean follow-up of 14.6 ± 16.9 months, ipsilateral stroke rates were similar across groups (urgent: 4.3%, early: 5.6%, delayed: 4.1%; P = 1.00). All-cause mortality at follow-up occurred in 21.3% of urgent, 10.0% of early, and 10.2% of delayed patients (P = 0.17). Restenosis and reintervention rates at follow-up were significantly higher in the urgent (10.6%) and delayed (14.3%) groups than the early group (2.2%; P = 0.01).
Urgent carotid revascularization is associated with higher perioperative stroke/TIA rate than early and delayed interventions. Mid-term outcomes were comparable across groups. Restenosis and reintervention rates were higher in the urgent and delayed groups than the early intervention group.
有症状的颈动脉狭窄需要及时干预以降低复发性中风的风险。然而，血管重建的最佳时机仍存在争议。本研究评估了接受紧急（<48小时）、早期（3 - 14天）或延迟（>14天）颈动脉血管重建的患者的预后。
这项回顾性队列研究纳入了186例有症状患者的干预措施，根据干预时机分为紧急组（症状发作后<48小时，n = 47）、早期组（3 - 14天，n = 90）和延迟组（>14天，n = 49）。分析了基线特征、手术细节和预后。预后指标包括围手术期中风、短暂性脑缺血发作（TIA）、心肌梗死以及30天和随访时的死亡率。
该队列的平均年龄为71.3±9.6岁，各组间无差异，性别分布均衡（P = 0.75）。合并症包括高血压、高脂血症和慢性肾病，各组相似（P>0.05）。入院时美国国立卫生研究院卒中量表评分在各组间有显著差异（紧急组：4.7±4.6；早期组：8.2±8.1；延迟组：4.0±5.2；P = 0.01）。出院时通过改良Rankin量表测量的残疾程度在各组间无显著差异（紧急组：0.9±1.3；早期组：1.1±1.3；延迟组：0.5±1.0；P = 0.09）。在30天时，紧急组有3例（6.4%）患者发生同侧中风/TIA，早期组和延迟组均无（P = 0.02）。紧急组有2例（4.3%）患者在30天内死亡，早期组有1例（1.1%）（P = 0.23）。紧急组的30天中风、TIA、心肌梗死或死亡的综合发生率显著高于早期组（紧急组：8.5%，早期组：1.1%，延迟组：0.0%；P = 0.02）。在平均随访14.6±16.9个月时，各组同侧中风发生率相似（紧急组：4.3%，早期组：5.6%，延迟组：4.1%；P = 1.00）。随访时全因死亡率在紧急组为21.3%，早期组为10.0%，延迟组为10.2%（P = 0.17）。随访时紧急组（10.6%）和延迟组（14.3%）的再狭窄和再次干预率显著高于早期组（2.2%；P = 0.01）。
与早期和延迟干预相比，紧急颈动脉血管重建与围手术期更高的中风/TIA发生率相关。中期预后在各组间相当。紧急组和延迟组的再狭窄和再次干预率高于早期干预组。
