Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery
Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery
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DOI：
10.1016/s0140-6736(04)15785-1
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发表时间：
2004-03-20
期刊：
影响因子：
168.9
通讯作者：
Barnett, HJM
中科院分区：
文献类型：
--
作者：
Rothwell, PM;Eliasziw, M;Barnett, HJM
背景颈动脉内膜切除术可降低近期有症状狭窄患者的卒中风险。受益取决于狭窄的程度，我们的目的是，看看它是否也可能取决于其他临床和血管造影的特点，并在手术的时机。方法我们分析了汇总数据从欧洲颈动脉手术试验和北美症状颈动脉内膜切除术试验。同侧缺血性中风的风险，患者的药物治疗，中风和死亡的围手术期风险，并从手术中的整体效益进行了测定有关的7个预定义和7个事后subgroup.Results 5893例33 000患者年的后续分析。性别（p=0.003）、年龄（p=0.03）和从最后一次症状性事件到随机化的时间（p=0.009）改变了手术的有效性。男性、75岁或以上患者以及末次缺血事件后2周内随机化的患者手术获益最大，并随着延迟时间的增加而迅速下降。对于50%或更高狭窄的患者，需要接受手术的患者数量（即，需要治疗的人数），以防止在5年内发生1例同侧卒中，男性为9例，女性为36例，75岁或以上为5例，65岁以下为18例，末次缺血事件后2周内随机分配的患者为5例，而超过12周后随机分配的患者为125例。这些结果是一致的，在各个trials.Interpretation：从动脉内膜切除术的好处不仅取决于颈动脉狭窄的程度，但也对其他几个临床特征，如延迟手术后，目前的事件。理想情况下，手术应在患者最后症状的2周内完成。
Background Carotid endarterectomy reduces the risk of stroke in patients with recently symptomatic stenosis. Benefit depends on the degree of stenosis, and we aimed to see whether it might also depend on other clinical and angiographic characteristics, and on the timing of surgery.Methods We analysed pooled data from the European Carotid Surgery Trial and North American Symptomatic Carotid Endarterectomy Trial. The risk of ipsilateral ischaemic stroke for patients on medical treatment, the perioperative risk of stroke and death, and the overall benefit from surgery were determined in relation to seven predefined and seven post hoc subgroups.Results 5893 patients with 33 000 patient-years of follow-up were analysed. Sex (p=0.003), age (p=0.03), and time from the last symptomatic event to randomisation (p=0.009) modified the effectiveness of surgery. Benefit from surgery was greatest in men, patients aged 75 years or older, and those randomised within 2 weeks after their last ischaemic event, and fell rapidly with increasing delay. For patients with 50% or higher stenosis, the number of patients needed to undergo surgery (ie, number needed to treat) to prevent one ipsilateral stroke in 5 years was nine for men versus 36 for women, five for age 75 years or older versus 18 for younger than 65 years, and five for those randomised within 2 weeks after their last ischaemic event, versus 125 for patients randomised after more than 12 weeks. These results were consistent across the individual trials.Interpretation: Benefit from endarterectomy depends not only on the degree of carotid stenosis, but also on several other clinical characteristics such as delay to surgery after the presenting event. Ideally, the procedure should be done within 2 weeks of the patient's last symptoms.