High-risk carotid endarterectomy: fact or fiction.
High-risk carotid endarterectomy: fact or fiction.
复制标题
高风险颈动脉内膜切除术：事实还是虚构。
DOI：
--
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发表时间：
2003
影响因子：
4.3
通讯作者：
J. Ricotta
中科院分区：
文献类型：
--
作者：
A. Gasparis;Lise Ricotta;S. Cuadra;D. Char;W. Purtill;P. V. van Bemmelen;G. Hines;F. Giron;J. Ricotta
目标
有人提出，病情不符合北美症状性颈动脉内膜切除术试验纳入标准或具有解剖学危险因素的患者构成颈动脉内膜切除术（CEA）的“高风险”群体，并且可能是初次颈动脉血管成形术支架置入术的候选者。我们的目标是审查一系列连续的孤立 CEA，确定此类高风险患者的数量，并确定他们的手术是否与并发症发生率增加有关。
方法
对 1996 年 6 月至 2001 年 6 月期间进行的连续孤立 CEA 进行了审查。高风险合并症包括：年龄 80 岁或以上 (n = 80)、纽约心脏协会 III/IV 级心绞痛 (n = 16)、加拿大 III/IV 级心力衰竭 (n = 4)、心肌梗塞 6 个月或以下 (n = 11)、类固醇依赖性或氧依赖性肺部疾病 (n = 4) 以及肌酐水平 3 或以上 (n = 13)。解剖学高风险的定义为：对侧闭塞（n = 66）、C（2）以上病变或需要二腹分割（n = 53）、再次手术（n = 29）和颈部放射（n = 3）。统计分析采用chi(2)分析。
结果
在审查的 788 名患者中，228 名 (29%) 被一项或多项先前标准归类为高风险（63% 合并症，28% 解剖学，9% 两者兼而有之）。所有患者组的术前神经症状和术后结果相似。所有患者的总中风和死亡率为 1.1%。 6 名患者术后发生中风（0.8%），3 名患者死于心肌梗塞（0.4%）。高风险组的中风和死亡率为 1.3%，而正常风险组的中风和死亡率为 1.1% (P =.51)。
结论
高风险 CEA 的概念必须重新审视。尽管按照其他人的定义，29% 的 CEA 患者属于高风险，但我们没有发现任何证据表明这会影响 CEA 后的结果。患有严重合并症、对侧颈动脉闭塞和颈动脉高位病变的患者可以接受手术，而不会增加并发症。如果存在高危人群，其规模较小且仅限于再次手术或颈部放射治疗（本系列中为 4%）。除了这种可能的例外，颈动脉血管成形术支架置入术应仅限于随机临床试验。
OBJECTIVE
It has been proposed that patients whose conditions do not meet North American Symptomatic Carotid Endarterectomy Trial inclusion criteria or have anatomic risk factors constitute a "high-risk" group for carotid endarterectomy (CEA) and might be candidates for primary carotid angioplasty stenting. Our objective was to review a consecutive series of isolated CEAs, identify the number of such patients at high risk, and determine whether their operations were associated with increased complication rate.
METHODS
Consecutive isolated CEAs performed between June 1996 and June 2001 were reviewed. High-risk comorbidities included: age 80 years or more (n = 80), New York Heart Association class III/IV angina (n = 16), Canadian class III/IV heart failure (n = 4), myocardial infarct 6 months or less (n = 11), steroid-dependent or oxygen-dependent pulmonary disease (n = 4), and creatinine level of 3 or more (n = 13). Anatomic high risk was defined by: contralateral occlusion (n = 66), lesion above C(2) or requirement of digastric division (n = 53), reoperation (n = 29), and neck radiation (n = 3). Statistical analysis was with chi(2) analysis.
RESULTS
Of 788 patients reviewed, 228 (29%) were classified as high risk by one or more of the previous criteria (63% comorbidity, 28% anatomy, 9% both). Presence of preoperative neurologic symptoms and postoperative results were similar across all patient groups. The total stroke and death rate was 1.1% for all the patients. Six patients had postoperative strokes (0.8%), and three patients died of myocardial infarcts (0.4%). The stroke and death rate was 1.3% in the high-risk group as compared with 1.1% in the normal-risk group (P =.51).
CONCLUSION
The concept of the high-risk CEA must be critically reexamined. Although 29% of patients for CEA were high risk as defined by others, we found no evidence that this influenced the results after CEA. Patients with significant medical comorbidities, contralateral carotid occlusion, and high carotid lesions can undergo operation without increased complications. If a high-risk group exists, it is small and restricted to reoperation or radiated neck (4% in this series). With this possible exception, carotid angioplasty stenting should be restricted to randomized clinical trials.
影响因子：
158.5
作者：
Inzitari, D;Eliasziw, M;Barnett, HJM
通讯作者：
Barnett, HJM
DOI：
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发表时间：
1991-08
期刊：
The New England Journal of Medicine
影响因子：
--
作者：
A. Buchan
通讯作者：
A. Buchan
影响因子：
2.8
作者：
Agmon, Y;Khandheria, BK;Seward, JB
通讯作者：
Seward, JB