无症状性颈动脉狭窄行颈动脉内膜剥脱术后的结果

Outcome after carotid endarterectomy for asymptomatic carotid stenosis.

作者信息

Libman R B, Sacco R L, Shi T, Correll J W, Mohr J P

机构信息

Department of Neurology, Columbia Presbyterian Medical Center, New York, NY.

出版信息

Surg Neurol. 1994 Jun;41(6):443-9. doi: 10.1016/0090-3019(94)90005-1.

DOI:10.1016/0090-3019(94)90005-1

PMID:8059320

Abstract

OBJECTIVE

To compare the long-term outcome in patients with asymptomatic carotid stenosis (ACS) among those treated with carotid endarterectomy (CE) or medical therapy.

BACKGROUND

Until randomized trials are completed, treatment of ACS will depend on identification of subgroups likely to benefit from CE.

METHODS

A retrospective cohort study was done on 215 patients with ACS: 107 underwent CE, and 108 were treated medically (MED). A neurologist reviewed medical records and performed a telephone interview to detect outcome (stroke and death). Mean follow-up was 3.8 years; only 4% were lost to follow-up.

RESULTS

Among CE patients, there was a 4.7% risk of postoperative ipsilateral stroke within 30 days. Four of five postoperative strokes occurred among patients with prior contralateral symptoms. There was no significant difference between CE and MED in the cumulative life-table 5-year risk of ipsilateral stroke, any stroke, or survival free of any stroke. Among diabetics, however, there were no ipsilateral strokes at 5 years after CE compared to 20% in MED (p = 0.03). Excluding postoperative complications, the 5-year risk of ipsilateral stroke was reduced among CE patients who "ever smoked" (CE 1%, MED 8%, p = 0.03) and the 5-year risk of any stroke was reduced among CE patients who had no prior myocardial infarction (CE 6%, MED 16%, p = 0.02). Among those with prior contralateral carotid territory symptoms, the 5-year risk of any stroke was worse in the MED patients (CE 5% MED 32%, p = 0.004). Among CE patients, a Cox proportional hazards model determined that the independent predictors of worse long-term outcome were: a history of myocardial infarction; admission systolic blood pressure greater than 160 mm Hg; and age greater than 65.

CONCLUSION

The approach to patients with ACS will await completion of large, randomized clinical trials, now in progress. Even if these studies are negative, there may remain specific subgroups of patients who show clear benefit from carotid endarterectomy.

摘要

目的

比较接受颈动脉内膜切除术（CE）或药物治疗的无症状性颈动脉狭窄（ACS）患者的长期预后。

背景

在随机试验完成之前，ACS的治疗将取决于识别可能从CE中获益的亚组。

方法

对215例ACS患者进行了一项回顾性队列研究：107例接受了CE治疗，108例接受了药物治疗（MED）。一名神经科医生查阅病历并进行电话访谈以检测预后（中风和死亡）。平均随访时间为3.8年；仅4%的患者失访。

结果

在接受CE治疗的患者中，30天内术后同侧中风风险为4.7%。五例术后中风中有四例发生在既往有对侧症状的患者中。在同侧中风、任何中风或无任何中风存活的累积生命表5年风险方面，CE和MED之间没有显著差异。然而，在糖尿病患者中，CE治疗后5年无同侧中风，而MED组为20%（p = 0.03）。排除术后并发症后，“曾经吸烟”的CE患者同侧中风的5年风险降低（CE为1%，MED为8%，p = 0.03），无既往心肌梗死的CE患者任何中风的5年风险降低（CE为6%，MED为16%，p = 0.02）。在既往有对侧颈动脉区域症状的患者中，MED患者任何中风的5年风险更高（CE为5%，MED为32%，p = 0.004）。在接受CE治疗的患者中，Cox比例风险模型确定长期预后较差的独立预测因素为：心肌梗死病史；入院收缩压大于160 mmHg；以及年龄大于65岁。