Stroke after carotid stenting and endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).
Stroke after carotid stenting and endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).
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DOI：
10.1161/circulationaha.112.120030
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发表时间：
2012-12-18
期刊：
影响因子：
37.8
通讯作者：
CREST Investigators
中科院分区：
文献类型：
--
作者：
Hill MD;Brooks W;Mackey A;Clark WM;Meschia JF;Morrish WF;Mohr JP;Rhodes JD;Popma JJ;Lal BK;Longbottom ME;Voeks JH;Howard G;Brott TG;CREST Investigators
与颈动脉内膜切除术相比，颈动脉支架置入术后更容易发生中风。关于中风类型、严重程度和特征的细节之前还没有报道。我们描述了在颈动脉内膜切除术与支架植入试验(CREST)中发生的卒中。CREST是一项随机、开放分配、对照试验，终点判定为盲法。卒中是主要综合结果的一个组成部分。随机分组后30天内接受指定治疗的患者也包括在内。中风由一个委员会认证的血管神经学家小组进行裁决，并对临床获得的脑图像进行二级中央审查。报告了卒中类型、偏侧性、时机和结局。在随机抽取的2502名患者中有81名患者发生了围手术期中风，在这项分析的2272名患者中有69名患者发生了围手术期中风。卒中主要为轻微卒中(81%，n=56)、缺血性卒中(90%，n=62)、前循环卒中(94%，n=65)和同侧卒中(88%，n=61)。术后3-21天共出血7例，死亡5例。2272例患者中有13例(0.6%)发生大卒中。卒中后四年死亡率估计为21.1%，而非卒中组为11.6%。围术期卒中后4年的调整死亡风险较高(HR=2.78，CI95 1·63~4·76)。在CREST颈动脉介入治疗后，卒中，尤其是严重卒中并不常见，但卒中与显著的发病率相关，并且独立地与未来死亡率增加近三倍相关。血运重建后重大和出血性卒中发生的时间延迟表明这些卒中可能是可以预防的。
Stroke occurs more commonly after carotid artery stenting than carotid endarterectomy. Details regarding stroke type, severity, and characteristics have not been previously reported. We describe the strokes occurring in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). CREST is a randomized, open-allocation, controlled trial with blinded endpoint adjudication. Stroke was a component of the primary composite outcome. Patients who received their assigned treatment within 30 days of randomization are included. Stroke was adjudicated by a panel of board-certified vascular neurologists with secondary central review of clinically-obtained brain images. Stroke type, laterality, timing, and outcome are reported. A periprocedural stroke occurred among 81 of the 2502 patients randomized and among 69 of the 2272 in this analysis. Strokes were predominantly minor (81%, n=56), ischemic (90%, n=62), in the anterior circulation (94%, n=65), and ipsilateral to the treated artery (88%, n=61). There were seven hemorrhages, occurring 3-21 days post-procedure, and five were fatal. Major stroke occurred in 13 (0·6%) of the 2272 patients. The estimated four-year mortality after stroke was 21·1% compared to 11·6% for those without stroke. The adjusted risk of death at four years was higher after periprocedural stroke (HR = 2·78, CI95 1·63-4·76). Stroke, particularly severe stroke, was uncommon after carotid intervention in CREST, but stroke was associated with significant morbidity and was independently associated with a near threefold increased future mortality. The delayed timing of major and hemorrhagic stroke after revascularization suggests that these strokes may be preventable.