Cao P, Giordano G, De Rango P, Ricci S, Zannetti S, Moggi L
Department of Surgery and Surgical Emergencies, University of Perugia, Italy.
Eur J Vasc Endovasc Surg. 1995 Jul;10(1):16-22. doi: 10.1016/s1078-5884(05)80193-5.
To analyse whether contralateral occlusion represents an additional perioperative risk factor in carotid endarterectomy (CEA), and whether long-term survival after surgery in patients with contralateral occlusion differs from that of patients without.
Retrospective clinical study.
Vascular Surgery Unit, Department of Surgery, University of Perugia, Perugia, Italy.
Fifty-five patients with carotid stenosis and contralateral occlusion undergoing CEA (Group 1) were compared with 110 patients (Group II), without contralateral occlusion selected from a cohort of 367 patients with a patent contralateral artery, matched for gender, age and ipsilateral symptoms.
Perioperative stroke/death rate at 30 days and minor complications in Group I vs. Group II over a mean follow-up of 38 months.
The perioperative stroke/death rate at 30 days was 0% in Group I and 2.7% in Group II (p = 0.6) while minor complications amounted to 11% in Group I and 5% in Group II (p = 0.2). Survival rates of patients free from stroke, using Kaplan Meier curves, were 79.4% in Group I and 83.3% in Group II (p = 0.4); stroke free rates were 92.8% and 94.3% in Groups I and II, respectively. The incidence of late stroke, fatal or not, in patients who had undergone CEA with contralateral obstruction was the same as in similarly operated patients without contralateral obstruction (7% vs. 6%). However, the incidence of late vascular death, exemplified by a crude rate of 14% vs. 6% (p = 0.1; O.R. = 2.50; C.I. = 0.77-8.25) was greater in patients with contralateral occlusion.
In this study, CEA in patients with contralateral occlusion was not associated with an increased perioperative morbidity/mortality rate. The higher incidence of vascular death in the late follow-up of patients with contralateral carotid occlusion, although not statistically significant, could indicate the presence of more severe systemic vascular disease.
分析对侧闭塞是否为颈动脉内膜切除术（CEA）围手术期的额外危险因素，以及对侧闭塞患者术后的长期生存率是否与无对侧闭塞患者不同。
回顾性临床研究。
意大利佩鲁贾大学外科血管外科病房。
55例患有颈动脉狭窄且对侧闭塞并接受CEA的患者（第1组）与110例无对侧闭塞的患者（第II组）进行比较，第II组患者从367例对侧动脉通畅的患者队列中选取，根据性别、年龄和同侧症状进行匹配。
第1组与第II组在30天时的围手术期卒中/死亡率以及在平均38个月的随访期内的轻微并发症。
第1组30天时的围手术期卒中/死亡率为0%，第II组为2.7%（p = 0.6），而第1组的轻微并发症为11%，第II组为5%（p = 0.2）。采用Kaplan Meier曲线，无卒中患者的生存率在第1组为79.4%，在第II组为83.3%（p = 0.4）；第1组和第II组的无卒中率分别为92.8%和94.3%。接受CEA且伴有对侧阻塞的患者中，无论是否致命，晚期卒中的发生率与未伴有对侧阻塞的类似手术患者相同（7%对6%）。然而，对侧闭塞患者的晚期血管性死亡率更高，粗死亡率分别为14%和6%（p = 0.1；比值比=2.50；可信区间=0.77 - 8.25）。
在本研究中，对侧闭塞患者的CEA与围手术期发病率/死亡率增加无关。对侧颈动脉闭塞患者在后期随访中血管性死亡发生率较高，尽管无统计学意义，但可能表明存在更严重的全身血管疾病。
