Changing Patterns of Carotid Endarterectomy Between 2011 and 2017 in England A Population-Based Cohort Study
Changing Patterns of Carotid Endarterectomy Between 2011 and 2017 in England A Population-Based Cohort Study
复制标题
DOI：
10.1161/strokeaha.119.025231
复制
发表时间：
2019-09-01
期刊：
影响因子：
8.3
通讯作者：
Cromwell, David A.
中科院分区：
文献类型：
--
作者：
Johal, Amundeep S.;Loftus, Ian M.;Cromwell, David A.
背景和目的-颈动脉内膜切除术（CEA）降低了近期有症状患者的卒中风险，而对无症状患者的作用较小。最近的证据表明，选举委员会的数目可能正在减少。本研究的目的是调查2011年至2017年英国无症状和有症状患者的CEA年度模式。方法-使用来自国家血管登记处的数据描述（1）2011年至2017年英格兰及其9个地理区域的CEA手术数量，（2）接受CEA的患者的特征，以及（3）CEA的发生率是否与每个区域内的血管动脉单位数量相关。每个地区的年卒中发病率来自官方人口数据和每年的指数卒中入院人数。结果-在英格兰进行的CEA总数从2011年的4992下降到2017年的3482，下降了30%。在有症状的患者中，有25%的下降，CEA的数量从4270下降到3217。在无症状患者中，2011年进行了722次CEA，2017年为265次，下降了63%。所有区域每100 000名成年人中的CEA随着时间的推移而下降，但各区域的变化幅度各不相同（范围为每100 000人1.7-5.5）。每年CEA的区域数量与区域卒中发病率的变化、在无症状患者中进行CEA的比例以及进行CEA的医院数量相关。这项基于人群的研究显示，2011年至2017年期间，无症状患者中CEA下降了63%，这可能是因为对CEA作用的态度发生了变化。有症状患者CEA下降25%的原因尚不清楚，因为英国CEA指南对这些患者没有改变。同侧狭窄50%至99%的症状性患者比例是否发生变化需要调查。
Background and Purpose- Carotid endarterectomy (CEA) reduces the risk of stroke in recently symptomatic patients and less so in asymptomatic patients. Recent evidence suggests that the number of CEAs may be declining. The aim of this study was to investigate annual patterns of CEA in asymptomatic and symptomatic patients in England from 2011 to 2017. Methods- Data from the National Vascular Registry were used to describe (1) the number of CEA procedures in England and its 9 geographic regions from 2011 to 2017, (2) the characteristics of patients undergoing CEA, and (3) whether rates of CEA correlated with the number of vascular arterial units within each region. Annual stroke incidence for each region was derived from official population figures and the number of index stroke admissions per year. Results- The overall number of CEAs performed in England fell from 4992 in 2011 to 3482 in 2017, a 30% decline. Among symptomatic patients, there was a 25% decline, the number of CEAs falling from 4270 to 3217. In asymptomatic patients, there were 722 CEAs performed in 2011 and 265 in 2017, a 63% decline. CEAs per 100 000 adults within all regions declined over time but the size of change varied across the regions (range, 1.7-5.5 per 100 000). The regional numbers of CEAs per year were associated with changes in the regional stroke incidence, the proportion of CEAs performed in asymptomatic patients, and the number of hospitals performing CEA. Conclusions- This population-based study revealed a 63% decline in CEAs among asymptomatic patients between 2011 and 2017, possibly because of changing attitudes in the role of CEA. Reasons for the 25% decline in CEAs among symptomatic patients are unclear as UK guidelines on CEA have not changed for these patients. Whether the proportion of symptomatic patients with 50% to 99% ipsilateral stenosis has changed requires investigation.