Understanding risk factors for perioperative ischemic events with carotid stenting: is patient age over 80 years or is unfavorable arch anatomy to blame?
Understanding risk factors for perioperative ischemic events with carotid stenting: is patient age over 80 years or is unfavorable arch anatomy to blame?
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DOI：
10.1136/neurintsurg-2013-010721
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发表时间：
2014-04-01
影响因子：
4.8
通讯作者：
Hopkins, L. Nelson
中科院分区：
文献类型：
--
作者：
Dumont, Travis M.;Mokin, Maxim;Hopkins, L. Nelson
有几项研究报告了≥ 80岁患者颈动脉支架植入术（CAS）后围手术期风险增加;然而，大多数研究并未将该人群中更常见的不利解剖特征视为混杂变量。本研究的目的是显示不良主动脉弓解剖结构和围手术期缺血并发症后CAS.MethodsOur前瞻性维护的数据库进行查询所有的CAS程序在2009年和2011年之间的症状患者之间的相关性。对连续CAS手术进行了回顾性分析。主要终点为围手术期（30天内）缺血性事件（卒中、短暂性脑缺血发作（TIA））。按年龄和解剖特征进行二分，比较两组之间的事件发生率。年龄组之间的不良弓（主动脉弓和治疗颈总动脉之间的锐角）的发病率进行了比较。ResultsPerioperative缺血性事件包括四个缺血性中风和三个TIA（所有事件同侧治疗血管）。主动脉弓解剖结构不良的患者（7.9%）的事件发生率高于主动脉弓特征良好的患者（0.7%）（p = 0.0073）。≥ 80岁患者的事件发生率（4.5%）与<80岁患者的事件发生率（2.3%）无统计学差异（p = 0.428）。年龄在80岁及以上的患者中，主动脉弓解剖结构不良的发生率增加（<80岁，29%;>= 80岁，52%; p <0.001）。CAS代表了所有年龄段患者的血运重建选择;然而，主动脉弓解剖结构不良的患者可能代表围手术期缺血事件风险相对较高的人群。
ObjectiveSeveral studies have reported increased perioperative risk after carotid artery stenting (CAS) for patients >= 80 years of age; however, most have not considered unfavorable anatomic features noted more frequently in this population as a confounding variable. The purpose of this study was to show a correlation between poor aortic arch anatomy and perioperative ischemic complications after CAS.MethodsOur prospectively maintained database was queried for all CAS procedures performed on symptomatic patients between 2009 and 2011. Retrospective analysis of consecutive CAS procedures was performed. The primary endpoint was perioperative (within 30 days) ischemic events (stroke, transient ischemic attack (TIA)). Event incidence was compared between groups dichotomized by age and anatomical features. Incidence of unfavorable arch (acute angle between aortic arch and treated common carotid artery) was compared between age groups.ResultsPerioperative ischemic events included four ischemic strokes and three TIAs (all events ipsilateral to the treated vessel). Event incidence was more frequent in patients with unfavorable arch anatomy (7.9%) than in those with favorable aortic arch features (0.7%) (p=0.0073). Event incidence in patients >= 80 years of age (4.5%) was not statistically different than that in patients < 80 years (2.3%) (p=0.428). Unfavorable aortic arch anatomy was increased in frequency in patients aged 80 years and over (< 80 years, 29%; >= 80 years, 52%; p < 0.001).ConclusionsIn the present series, the incidence of perioperative complications was increased in patients with unfavorable aortic arch anatomy but not in patients >= 80 years. CAS represents a revascularization option for patients of all ages; however, patients with unfavorable aortic arch anatomy may represent a group at relatively high risk for periprocedural ischemic events.