Effect of patching on reducing restenosis in the carotid revascularization endarterectomy versus stenting trial.
Effect of patching on reducing restenosis in the carotid revascularization endarterectomy versus stenting trial.
复制标题
修补对减少颈动脉血运重建内膜切除术与支架试验的减少再狭窄的影响。
DOI：
10.1161/strokeaha.114.007634
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发表时间：
2015-03
期刊：
影响因子：
8.3
通讯作者：
Brott TG
中科院分区：
文献类型：
--
作者：
Malas M;Glebova NO;Hughes SE;Voeks JH;Qazi U;Moore WS;Lal BK;Howard G;Llinas R;Brott TG
目的是确定颈动脉内膜切除术（CEA）期间的修补是否影响围手术期和长期再狭窄、卒中、死亡和MI的风险（与初次闭合相比）。我们确定了所有在CREST接受随机化和CEA的患者。将接受补片治疗的CEA患者与接受CEA但未使用补片进行一期缝合的患者进行比较。我们比较了两组的围手术期和4年事件发生率、2年再狭窄率和再手术率。我们进一步分析了外科医生专业的结果。有1，151例患者接受了CEA（753例（65%）使用补片; 329例（29%）使用一期缝合）。我们排除了44例接受外翻CEA的患者和25例缺失CEA数据的患者（5%）。贴片的使用因外科医生的专业而异：89%的血管外科医生、6%的神经外科医生和76%的胸外科医生使用贴片。比较接受补片的患者与未接受补片的患者，两年再狭窄风险显著降低，并且在外科医生专业调整后持续存在（HR 0.35，95% CI 0.16-0.74，P= 0.006）。围手术期卒中和死亡率（HR 1.58，95% CI 0.33-7.58，P= 0.57）、即刻再次手术率（HR 0.6，95% CI 0.16-2.27，P= 0.45）或4年同侧卒中风险（HR 1.23，95% CI 0.42-3.63，P= 0.71）无显著差异。CEA中的补片闭合与再狭窄的减少相关，但与临床结局的改善无关。因此，应考虑更广泛地使用修补，以提高长期耐久性。 http://clinicaltrials.gov/show/NCT00004732
The purpose is to determine whether patching during carotid endarterectomy (CEA) affects the perioperative and long-term risks of restenosis, stroke, death, and MI as compared to primary closure. We identified all patients who were randomized and underwent CEA in CREST. CEA patients who received a patch were compared to patients who underwent CEA with primary closure without a patch. We compared peri-procedural and 4-year event rates, 2-year restenosis rates, and rates of reoperation between the two groups. We further analyzed results by surgeon specialty. There were 1,151 patients who underwent CEA (753 (65%) with patch; 329 (29%) with primary closure). We excluded 44 patients who underwent eversion CEA and 25 patients missing CEA data (5%). Patch use differed by surgeon specialty: 89% of vascular surgeons, 6% of neurosurgeons, and 76% of thoracic surgeons patched. Comparing patients who received a patch versus those who did not, there was a significant reduction in the two-year risk of restenosis, and this persisted after adjustment by surgeon specialty (HR 0.35, 95% CI 0.16–0.74, P=.006). There were no significant differences in the rates of periprocedural stroke and death (HR 1.58, 95% CI 0.33–7.58, P=.57), in immediate re-operation (HR 0.6, 95% CI 0.16–2.27, P=.45), or in the four-year risk of ipsilateral stroke (HR 1.23, 95% CI 0.42–3.63, P=.71). Patch closure in CEA is associated with reduction in restenosis though it is not associated with improved clinical outcomes. Thus, more widespread use of patching should be considered to improve long-term durability. http://clinicaltrials.gov/show/NCT00004732