Identification of patient characteristics that may improve procedure selection for the treatment of carotid stenosis.

IF 8.6 1区 医学 Q1 SURGERY British Journal of Surgery Pub Date : 2024-10-01 DOI:10.1093/bjs/znae227
Andreas Kuehnl, Christoph Knappich, Felix Kirchhoff, Bianca Bohmann, Vanessa Lohe, Shamsun Naher, Hans-Henning Eckstein, Michael Kallmayer
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Abstract

Background: Carotid endarterectomy and carotid artery stenting are common procedures for the treatment of carotid artery stenosis. The aim of this study was to identify factors that modify the effect between type of treatment and outcome, and could thus be used to refine the selection of treatment procedure.

Methods: All patients who underwent either carotid endarterectomy or carotid artery stenting between 2012 and 2018 in German hospitals were included. The analysis of effect modification was focused on baseline patient characteristics. The outcome was a composite of any stroke or death until discharge from hospital. For multivariable analyses, a generalized linear mixed regression model was used.

Results: Some 221 282 patients were included, of whom 68% were male. In patients who underwent carotid endarterectomy or carotid artery stenting, the risk of any stroke or death was 2.3% and 3.7% respectively. Patient age was statistically significantly associated with a higher risk of a composite outcome of any stroke or death (main effect of age: adjusted OR 1.21 (95% c.i. 1.17 to 1.26), P < 0.001). The age effect was stronger in patients treated with carotid artery stenting (interaction effect: adjusted OR 1.29 (95% c.i. 1.20 to 1.38), P < 0.001). Statistically significant interaction effects were identified for side of treatment, ASA grade, contralateral degree of stenosis, and the time interval between the index event and treatment.

Conclusion: This analysis shows that carotid artery stenting may be particularly disadvantageous in older patients, in patients with right-sided stenosis, and in symptomatic patients treated within the first 2 days after the index event. In patients with contralateral occlusion, carotid artery stenting appears equivalent to carotid endarterectomy.

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确定可改进颈动脉狭窄治疗手术选择的患者特征。
背景:颈动脉内膜剥脱术和颈动脉支架植入术是治疗颈动脉狭窄的常见方法。本研究的目的是找出改变治疗类型和结果之间影响的因素,从而用于改进治疗程序的选择:方法:纳入2012年至2018年期间在德国医院接受颈动脉内膜切除术或颈动脉支架植入术的所有患者。效果修正分析主要针对患者的基线特征。结果为出院前任何一次中风或死亡的复合结果。多变量分析采用广义线性混合回归模型:结果:共纳入约 221 282 例患者,其中 68% 为男性。在接受颈动脉内膜切除术或颈动脉支架植入术的患者中,发生中风或死亡的风险分别为 2.3% 和 3.7%。从统计学角度看,患者年龄与中风或死亡的复合风险较高密切相关(年龄的主效应:调整后 OR 1.21(95% c.i.1.17-1.26),P <0.001)。在接受颈动脉支架治疗的患者中,年龄效应更强(交互效应:调整后 OR 为 1.29(95% 置信区间为 1.20 至 1.38),P <0.001)。治疗侧、ASA分级、对侧狭窄程度以及指数事件与治疗之间的时间间隔均有统计学意义的交互作用:这项分析表明,颈动脉支架植入术对年龄较大的患者、右侧狭窄患者以及在指数事件发生后两天内接受治疗的无症状患者尤为不利。对于对侧闭塞的患者,颈动脉支架植入术似乎与颈动脉内膜剥脱术效果相当。
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来源期刊
CiteScore
12.70
自引率
7.30%
发文量
1102
审稿时长
1.5 months
期刊介绍: The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.
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