Stenting versus endarterectomy for treatment of carotid-artery stenosis.
Stenting versus endarterectomy for treatment of carotid-artery stenosis.
复制标题
DOI：
10.1056/nejmoa0912321
复制
发表时间：
2010-07-01
期刊：
影响因子：
--
通讯作者：
CREST Investigators
中科院分区：
文献类型：
--
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
颈动脉狭窄是中风的重要原因，颈动脉支架植入术和颈动脉内膜切除术都是治疗颈动脉狭窄的选择。我们将有症状或无症状的颈动脉狭窄患者随机分配接受颈动脉支架植入术或颈动脉内膜切除术。主要复合终点为卒中、心肌梗死或围手术期任何原因的死亡或随机分组后4年内的任何同侧卒中。2502例患者中位随访期为2.5年，支架组和动脉内膜切除术组的主要终点的估计4年发生率无显著差异（分别为7.2%和6.8%;支架组的风险比为1.11; 95%置信区间为0.81 - 1.51; P = 0.51）。根据症状状态（P = 0.84）或性别（P = 0.34），在主要终点方面没有差异性治疗效果。支架植入术和动脉内膜切除术的4年卒中或死亡率分别为6.4%和4.7%（风险比，1.50; P = 0.03）;有症状患者的发生率分别为8.0%和6.4%无症状患者的发生率分别为4.5%和2.7%（危险比，1.86，P = 0.07）。支架组和动脉内膜切除术组的围手术期终点的各个组成部分的发生率不同：死亡（0.7% vs. 0.3%，P = 0.18）、卒中（4.1% vs. 2.3%，P = 0.01）和心肌梗死（1.1% vs. 2.3%，P = 0.03）。此后，支架植入术和动脉内膜切除术的同侧卒中发生率同样较低（分别为2.0%和2.4%; P = 0.85）。在有症状或无症状颈动脉狭窄的患者中，接受颈动脉支架植入术的组和接受颈动脉内膜切除术的组中中风、心肌梗死或死亡的复合主要结局风险没有显着差异。在围手术期，支架植入术的卒中风险较高，动脉内膜切除术的心肌梗死风险较高。（ClinicalTrials.gov编号，NCT 00004732。）
Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P = 0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P = 0.84) or sex (P = 0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P = 0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P = 0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P = 0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P = 0.18), for stroke (4.1% vs. 2.3%, P = 0.01), and for myocardial infarction (1.1% vs. 2.3%, P = 0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P = 0.85). Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.)