Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
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在可比医疗风险患者中颈动脉内膜切除术与支架置入术的结果。
DOI：
10.1016/j.jvs.2014.05.044
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发表时间：
2014
影响因子：
4.3
通讯作者：
VascularStudyGroupofNewEngland
中科院分区：
文献类型：
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作者：
Spangler,EmilyL;Goodney,PhilipP;Schanzer,Andres;Stone,DavidH;Schermerhorn,MarcL;Powell,RichardJ;Cronenwett,JackL;Nolan,BrianW;VascularStudyGroupofNewEngland
在医学高危患者中，颈动脉支架植入术（CAS）和颈动脉内膜切除术（CEA）之间的选择可能很困难。本研究的目的是比较风险分层的结果CAS和CEA.MethodsPatients谁经历了孤立的原发性CEA（n = 11，336）或原发性CAS（n = 544）在29个中心的血管研究组的新英格兰进行了分析（2003-2013年）;与以前同侧CEA或CAS，或伴随冠状动脉旁路移植术的患者被排除在外。使用考克斯比例风险模型，根据预测的5年死亡率为每例患者制定医疗风险评分。风险评分最高四分位数的患者被称为高风险（其他三个四分位数为正常风险）。医学高危患者的5年生存率为65%，其中CEA患者为23%，CAS患者为25%。神经系统症状和无症状patients.ResultsAmong无症状的患者，在医院中风和/或死亡率之间CAS和CEA在正常和高风险的队列，范围从0.7%的正常风险CEA患者的1.6%，在高风险CAS患者之间没有差异。在有症状的患者中，与正常风险和高风险患者中的CEA相比，CAS的结局明显更差。正常风险的有症状患者的脑卒中或死亡率在CEA组为1.3%，而在CAS组为5.2%（P<0.01）。在高危症状患者中，CEA组的卒中或死亡率为1.5%，CAS组为9.3%（P<0.01）。在卒中、死亡或心肌梗死以及同侧卒中、严重卒中或死亡的次要结局指标的风险分层中，无症状CEA和CAS之间无显著差异。然而，有症状的高风险的CAS患者有显着更大的所有次要结果比CEA除死亡率，和有症状的正常风险的CAS患者只有显着更高的死亡率和中风，死亡，或myocardialinfarction.ConclusionsIn the Vascular Study Group of新英格兰，无症状的正常和高风险的患者做同样好后CEA或CAS。然而，与CEA相比，正常和高风险症状患者的CAS结局更差。在有症状的患者中，仅高医疗风险可能不足以作为CAS的适应症。
ObjectiveIn medically high-risk patients the choice between carotid artery stenting (CAS) and carotid endarterectomy (CEA) can be difficult. The purpose of this study was to compare risk-stratified outcomes of CAS and CEA.MethodsPatients who underwent isolated primary CEA (n = 11,336) or primary CAS (n = 544) at 29 centers in the Vascular Study Group of New England were analyzed (2003-2013); patients with previous ipsilateral CEA or CAS, or concomitant coronary artery bypass graft were excluded. A medical risk score based on predicted 5-year mortality was developed for each patient using a Cox proportional hazards model. Patients in the highest risk score quartile were termed high-risk (vs normal-risk for the other three quartiles). Medically high-risk patients had a 5-year survival of 65% and comprised 23% of CEA and 25% of CAS patients. Risk-stratified outcomes were compared within neurologically symptomatic and asymptomatic patients.ResultsAmong asymptomatic patients, rates of in-hospital stroke and/or death were not different between CAS and CEA in normal and high-risk cohorts, ranging from 0.7% in normal-risk CEA patients to 1.6% in high-risk CAS patients. In symptomatic patients, significantly worse outcomes were seen with CAS compared with CEA in normal-risk and high-risk patients. Normal-risk symptomatic patients had a stroke or death rate of 1.3% with CEA, but 5.2% with CAS (P< .01). In high-risk symptomatic patients, the stroke or death rate was 1.5% with CEA and 9.3% with CAS (P< .01). No significant differences were seen between asymptomatic CEA and CAS within risk strata across secondary outcome measures of stroke, death, or myocardial infarction, and ipsilateral stroke, major stroke, or death. However, symptomatic high-risk CAS patients had significantly greater rates of all secondary outcomes compared with CEA except death, and symptomatic normal-risk CAS patients had only significantly greater rates of death and stroke, death, or myocardial infarction.ConclusionsIn the Vascular Study Group of New England, asymptomatic normal- and high-risk patients do equally well after CEA or CAS. However, normal- and high-risk symptomatic patients have substantially worse outcomes with CAS compared with CEA. High medical risk alone might be an insufficient indication for CAS in symptomatic patients.
DOI：
10.1056/nejmoa0912321
发表时间：
2010-07-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Brott TG;Hobson RW 2nd;Howard G;Roubin GS;Clark WM;Brooks W;Mackey A;Hill MD;Leimgruber PP;Sheffet AJ;Howard VJ;Moore WS;Voeks JH;Hopkins LN;Cutlip DE;Cohen DJ;Popma JJ;Ferguson RD;Cohen SN;Blackshear JL;Silver FL;Mohr JP;Lal BK;Meschia JF;CREST Investigators
通讯作者：
CREST Investigators
影响因子：
4.3
作者：
Jessica B. Wallaert;J. Cronenwett;D. Bertges;A. Schanzer;R. D. Martino;B. Nolan;J. Eldrup;P. Goodney
通讯作者：
P. Goodney
高风险颈动脉内膜切除术：事实还是虚构。
影响因子：
4.3
作者：
A. Gasparis;Lise Ricotta;S. Cuadra;D. Char;W. Purtill;P. V. van Bemmelen;G. Hines;F. Giron;J. Ricotta
通讯作者：
J. Ricotta