Carotid revascularization immediately before urgent cardiac surgery practice patterns associated with the choice of carotid artery stenting or endarterectomy: a report from the CARE (Carotid Artery Revascularization and Endarterectomy) registry.
Carotid revascularization immediately before urgent cardiac surgery practice patterns associated with the choice of carotid artery stenting or endarterectomy: a report from the CARE (Carotid Artery Revascularization and Endarterectomy) registry.
复制标题
紧急心脏手术前的颈动脉血运重建实践模式与颈动脉支架置入术或动脉内膜切除术的选择相关：来自 CARE（颈动脉血运重建和动脉内膜切除术）登记处的报告。
DOI：
10.1016/j.jcin.2011.09.010
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Rosenfield,Kenneth
中科院分区：
文献类型：
--
作者：
Don,CreightonW;House,John;White,Christopher;Kiernan,Thomas;Weideman,Mary;Ruggiero,Nicholas;McCann,Andrew;Rosenfield,Kenneth
目的：研究紧急心脏手术前动脉内膜切除术（CEA）与支架植入术（CAS）的相关特征。背景：心脏手术前颈动脉血运重建的最佳方式尚不清楚。方法回顾性评价2005年1月至2010年4月在急诊心脏手术前30天内行颈动脉血管重建术和动脉内膜切除术的患者。比较基线特征，并进行多变量调整。结果451例符合研究标准的患者中，255例行CAS， 196例行CEA。随着时间的推移，这两种手术的增加程度相似（p = 0.18）。接受CAS的患者有更频繁的外周动脉疾病（38.2% vs. 26.5%, p < 0.01）、颈部手术（5.5% vs. 1.0%, p = 0.01）、颈部放疗（4.3% vs. 1.0%, p = 0.04）、左主干冠状动脉疾病（34.8% vs. 23.5%, p < 0.01）、神经系统事件（45.8% vs. 31.3%, p < 0.01）、颈动脉干预（20.8% vs. 7.6%, p < 0.01）和较高的基线肌酐（1.3 vs. 1.1 mg/dl, p = 0.02）。CAS患者的靶颈动脉在血运重建术前6个月更容易出现症状和既往CEA再狭窄。接受CAS的患者有较低的美国麻醉学会分级。中西部地区实施CAS的可能性低于CEA地区，而其他地区实施CAS的可能性更高（p < 0.01）。非高加索人种、心力衰竭史、颈动脉手术史、卒中史、左主干冠状动脉狭窄、较低的美国麻醉学会分级和教学医院是患者接受CAS的独立预测因素。结论紧急心脏手术患者颈动脉支架置入术和CEA增加。接受CAS的患者有更多的血管疾病，但较低的急性术前风险。在程序选择上存在显著的区域差异。
ObjectivesWe describe characteristics associated with use of endarterectomy (CEA) versus stenting (CAS) in patients before urgent cardiac surgery.BackgroundThe optimal modality of carotid revascularization preceding cardiac surgery is unknown.MethodsRetrospective evaluation of the CARE (Carotid Artery Revascularization and Endarterectomy) registry from January 2005 to April 2010 was performed on patients undergoing CEA or CAS preceding urgent cardiac surgery within 30 days. Baseline characteristics were compared, and multivariate adjustment was performed.ResultsOf 451 patients who met study criteria, 255 underwent CAS and 196 underwent CEA. Both procedures increased over time to a similar degree (p = 0.18). Patients undergoing CAS had more frequent history of peripheral artery disease (38.2% vs. 26.5%, p < 0.01), neck surgery (5.5% vs. 1.0%, p = 0.01), neck radiation (4.3% vs. 1.0%, p = 0.04), left-main coronary disease (34.8% vs. 23.5%, p < 0.01), neurological events (45.8% vs. 31.3%, p < 0.01), carotid intervention (20.8% vs. 7.6%, p < 0.01), and higher baseline creatinine (1.3 vs. 1.1 mg/dl, p = 0.02). The target carotid arteries of CAS patients were more likely to be symptomatic in the 6 months before revascularization and have restenosis from prior CEA. Patients undergoing CAS had a lower American Society of Anesthesiology grade. Midwest hospitals were less likely to perform CAS than CEA, whereas in the other regions CAS was more common (p < 0.01). Non-Caucasian race, a history of heart failure, previous carotid procedures, prior stroke, left main coronary artery stenosis, lower American Society of Anesthesiology grade, and teaching hospital were independent predictors of patients who would receive CAS.ConclusionsCarotid artery stenting and CEA have increased among patients undergoing urgent cardiac surgery. Patients who underwent CAS had more vascular disease but lower acute pre-surgical risk. Significant regional variation in procedure selection exists.
登录
查看更多内容
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
血管内颈动脉支架置入术和早期冠状动脉旁路移植术治疗无症状颈动脉狭窄：长期结果和神经系统事件
影响因子：
2.3
作者：
Priyantha Ranaweera;Brian Bigelow;M. Leary;Ralph de la Torre;F. Sellke;L. Garcia
通讯作者：
L. Garcia
使用颈动脉支架进行分期颈动脉和冠状动脉血运重建有什么好处吗？
影响因子：
8.3
作者：
M. Randall;F. McKevitt;T. Cleveland;P. Gaines;G. Venables
通讯作者：
G. Venables
冠状动脉内伽玛放射治疗支架内再狭窄后的五年随访
影响因子：
37.8
作者：
R. Waksman;A. Ajani;Roger L. White;R. Chan;B. Bass;A. Pichard;L. Satler;K. Kent;R. Torguson;R. Deible;E. Pinnow;J. Lindsay
通讯作者：
J. Lindsay
合并严重冠状动脉和颈动脉疾病患者的管理：有完美的解决方案吗？
影响因子：
37.8
作者：
M. Roffi
通讯作者：
M. Roffi