Hallett J W, Pietropaoli J A, Ilstrup D M, Gayari M M, Williams J A, Meyer F B
Division of Vascular Surgery, Mayo Foundation, Rochester, Minn 55905, USA.
J Vasc Surg. 1998 May;27(5):845-50; discussion 851. doi: 10.1016/s0741-5214(98)70264-2.
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) advocated the use of carotid endarterectomy (CEA) for transient ischemic attacks (TIAs), nondisabling strokes, and ipsilateral high-grade stenosis in highly selected patients. Whether similar results are achieved when CEA is applied to an entire geographically defined population is unknown but important if the NASCET recommendations are to be applied broadly to all community patients.
To determine the survival rate to ipsilateral stroke after CEA for all symptomatic patients in a defined population, we reviewed the medical records of all patients residing in Olmsted County, Minn. (approximately 100,000), who underwent a CEA for TIA or nondisabling stroke between 1970 and 1995. Their outcomes were compared with the NASCET results.
In the community of Olmsted County, 297 patients (108 women and 189 men) underwent 322 CEAs during the study period. TIAs or nondisabling stroke was the indication in 254 patients (86%), whereas the remaining 14% had asymptomatic stenosis. After CEA for symptomatic lesions, survival rate free of ipsilateral stroke was 97% at 2 years, 93% at 5 years, and 92% at 10 years. These results are similar to the NASCET survival rates free of ipsilateral stroke at 2 years (91%). However, the 30-day postoperative stroke rate for patients older than 80 years was significantly higher than that for patients younger than 80 years.
When the NASCET results are compared with a population-based experience in which all symptomatic patients undergoing CEA were analyzed, the early outcomes were similar. Our population-based data also document the remarkably durable long-term results of CEA in preventing stroke and present another benchmark for carotid stent angioplasty.
北美症状性颈动脉内膜切除术试验（NASCET）提倡在经过严格筛选的患者中，对短暂性脑缺血发作（TIA）、非致残性卒中以及同侧高度狭窄患者使用颈动脉内膜切除术（CEA）。当CEA应用于整个地理区域界定的人群时是否能取得类似结果尚不清楚，但如果要将NASCET的建议广泛应用于所有社区患者，这一点很重要。
为确定在特定人群中所有症状性患者接受CEA后同侧卒中的生存率，我们回顾了明尼苏达州奥尔姆斯特德县（约100,000人）所有在1970年至1995年间因TIA或非致残性卒中接受CEA的患者的病历。将他们的结果与NASCET的结果进行比较。
在奥尔姆斯特德县社区，在研究期间有297例患者（108例女性和189例男性）接受了322次CEA。254例患者（86%）的指征为TIA或非致残性卒中，其余14%有无症状性狭窄。对有症状性病变进行CEA后，2年时无同侧卒中的生存率为97%，5年时为93%，10年时为92%。这些结果与NASCET 2年时无同侧卒中的生存率（91%）相似。然而，80岁以上患者术后30天的卒中发生率显著高于80岁以下患者。
当将NASCET的结果与对所有接受CEA的症状性患者进行分析的基于人群的经验进行比较时，早期结果相似。我们基于人群的数据还记录了CEA在预防卒中方面显著持久的长期结果，并为颈动脉支架血管成形术提供了另一个基准。
