Stroke and Mortality Following Carotid Endarterectomy or Carotid Artery Stenting: A 10 Year Nationwide Study in France.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE European Journal of Vascular and Endovascular Surgery Pub Date : 2024-10-25 DOI:10.1016/j.ejvs.2024.10.031

Eric Steinmetz, Jonathan Cottenet, Anne-Sophie Mariet, Lucas Morin, Alain Bernard, Yannick Béjot, Catherine Quantin

{"title":"Stroke and Mortality Following Carotid Endarterectomy or Carotid Artery Stenting: A 10 Year Nationwide Study in France.","authors":"Eric Steinmetz, Jonathan Cottenet, Anne-Sophie Mariet, Lucas Morin, Alain Bernard, Yannick Béjot, Catherine Quantin","doi":"10.1016/j.ejvs.2024.10.031","DOIUrl":null,"url":null,"abstract":"Objective: This retrospective, nationwide cohort study aimed compare periprocedural stroke or death within 30 days of the procedure (PPSD30) in patients who underwent carotid endarterectomy (CEA) or carotid stenting (CAS).Methods: This retrospective cohort study used data from the French hospital database PMSI. All patients who underwent CEA or CAS between 2010 and 2019 in France were included. Information on individual patients and hospital characteristics was retrieved. A random effects logistic regression model compared the occurrence of PPSD30 after CEA or CAS. High surgical risk was accounted for by using propensity score matching and adjusted for patient and hospital characteristics. Analyses were also stratified to consider symptomatic and asymptomatic patients separately.Results: Between 2010 and 2019, 164 248 patients underwent a carotid artery procedure in France: 156 561 CEA and 7 687 CAS (including about 25.0% asymptomatic women and 40.0% high risk patients). The PPSD30 rate was 1.5% overall (n = 2 514 patients) (1.5% after CEA vs. 2.4% after CAS), 1.3% in asymptomatic patients (1.2% after CEA vs. 1.8% after CAS), and 3.3% in symptomatic patients (3.1% after CEA vs. 6.5% after CAS). After matching and adjustment, the risk of PPSD30 was statistically significantly greater in patients who underwent CAS than in patients who underwent CEA (adjusted OR [aOR] 1.4, 95% CI 1.1 - 1.8 in overall patients; aOR 1.4, 95% CI 1.1 - 1.8 in asymptomatic patients; and aOR 2.7, 95% CI 1.8 - 4.0 in symptomatic patients).Conclusion: This nationwide real life study showed that CEA performed better than CAS, more markedly in symptomatic patients, but also in asymptomatic patients. Moreover, many patients received procedures that were more likely to be harmful than beneficial according to conclusions from past randomised trials (i.e., all asymptomatic women, all high surgical risk patients, and all who had undergone CAS).","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ejvs.2024.10.031","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: This retrospective, nationwide cohort study aimed compare periprocedural stroke or death within 30 days of the procedure (PPSD30) in patients who underwent carotid endarterectomy (CEA) or carotid stenting (CAS).

Methods: This retrospective cohort study used data from the French hospital database PMSI. All patients who underwent CEA or CAS between 2010 and 2019 in France were included. Information on individual patients and hospital characteristics was retrieved. A random effects logistic regression model compared the occurrence of PPSD30 after CEA or CAS. High surgical risk was accounted for by using propensity score matching and adjusted for patient and hospital characteristics. Analyses were also stratified to consider symptomatic and asymptomatic patients separately.

Results: Between 2010 and 2019, 164 248 patients underwent a carotid artery procedure in France: 156 561 CEA and 7 687 CAS (including about 25.0% asymptomatic women and 40.0% high risk patients). The PPSD30 rate was 1.5% overall (n = 2 514 patients) (1.5% after CEA vs. 2.4% after CAS), 1.3% in asymptomatic patients (1.2% after CEA vs. 1.8% after CAS), and 3.3% in symptomatic patients (3.1% after CEA vs. 6.5% after CAS). After matching and adjustment, the risk of PPSD30 was statistically significantly greater in patients who underwent CAS than in patients who underwent CEA (adjusted OR [aOR] 1.4, 95% CI 1.1 - 1.8 in overall patients; aOR 1.4, 95% CI 1.1 - 1.8 in asymptomatic patients; and aOR 2.7, 95% CI 1.8 - 4.0 in symptomatic patients).

Conclusion: This nationwide real life study showed that CEA performed better than CAS, more markedly in symptomatic patients, but also in asymptomatic patients. Moreover, many patients received procedures that were more likely to be harmful than beneficial according to conclusions from past randomised trials (i.e., all asymptomatic women, all high surgical risk patients, and all who had undergone CAS).

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

颈动脉内膜剥脱术或颈动脉支架术后的中风和死亡率：法国一项为期 10 年的全国性研究。

研究目的这项全国性回顾性队列研究旨在比较接受颈动脉内膜剥脱术（CEA）或颈动脉支架置入术（CAS）的患者在手术后 30 天内发生的围手术期中风或死亡（PPSD30）：这项回顾性队列研究使用的数据来自法国医院数据库PMSI。研究纳入了 2010 年至 2019 年期间在法国接受 CEA 或 CAS 手术的所有患者。研究检索了患者个体信息和医院特征。随机效应逻辑回归模型比较了CEA或CAS术后PPSD30的发生率。高手术风险通过倾向评分匹配进行考虑，并根据患者和医院特征进行调整。分析还进行了分层，分别考虑了无症状和无症状患者：2010年至2019年期间，法国有164 248名患者接受了颈动脉手术：156 561例CEA和7 687例CAS（包括约25.0%的无症状女性和40.0%的高风险患者）。总体PPSD30率为1.5%（n = 2 514例患者）（CEA术后为1.5%，CAS术后为2.4%），无症状患者为1.3%（CEA术后为1.2%，CAS术后为1.8%），有症状患者为3.3%（CEA术后为3.1%，CAS术后为6.5%）。经过匹配和调整后，接受CAS的患者发生PPSD30的风险在统计学上明显高于接受CEA的患者（总体患者的调整OR[aOR]为1.4，95% CI为1.1 - 1.8；无症状患者的调整OR为1.4，95% CI为1.1 - 1.8；有症状患者的调整OR为2.7，95% CI为1.8 - 4.0）：这项全国范围的实际研究表明，CEA的疗效优于CAS，在有症状的患者中表现更为明显，但在无症状的患者中也是如此。此外，根据以往随机试验的结论，许多患者接受了弊大于利的手术（即所有无症状女性、所有手术风险高的患者以及所有接受过 CAS 的患者）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.