Sex-Related Outcomes in Asymptomatic Patients Undergoing Carotid Artery Stenting.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Journal of Endovascular Therapy Pub Date : 2025-04-01 Epub Date: 2023-05-16 DOI:10.1177/15266028231172356
Claudio Desantis, Sergio Zacà, Paola Wiesel, Giovanni Mastrangelo, Raffaele Pulli, Domenico Angiletta
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引用次数: 0

Abstract

Purpose: Aim of the study was to evaluate the influence of sex in asymptomatic patients undergoing carotid artery stenting (CAS).

Materials and methods: A retrospective observational study was conducted from January 2006 to December 2020. A total of 438 consecutive patients with asymptomatic carotid artery stenosis >70% underwent transfemoral CAS and were stratified in males (M) and females (F). Periprocedural 30-day outcomes were: stroke, death, and myocardial infarction (MI). Follow-up outcomes were: death and stroke rates (primary) and freedom from restenosis (FFR) and reintervention rates (secondary). Follow-up data were analyzed at 1, 5, and 10 years. Data were analyzed with χ2 test and Fisher's exact test and follow-up outcomes with Kaplan-Meier curves. The log-rank test was used to determine differences between the groups and univariate analysis to identify the association between risk factors and intraoperative details with mortality and restenosis rates.

Results: A total of 462 procedures were performed (M: n=321, 69.4%), in which 24 CAS were bilateral (5.5%). Mean age was 71.9±7.6 years (M: 72.1±7.8; F: 71.7±7.3). Periprocedural outcomes were: stroke rate 2.2% (n=10; M: n=5, 1.6%; F: n=5, 3.5%; p=0.176), mortality rate 0.6% (M: n=3, p=0.334), and stroke/death rate 2.8% (n=13; M: n=8, 2.5%; F: n=5, 3.5%; p=0.528); no cardiac events (MI) were recorded. A not-disabling (minor) stroke was detected in 3 males (0.9%), while a disabling (major) stroke was reported in 7 patients (1.7%) of whom 5 were ischemic events (M: n=2, 0.6%; F: n=3, 2.2%) and 2 were cerebral hemorrhages (F: 1.3%, p=0.046). Mean follow-up was 73.66±40.83 months (M: 72.66; F: 76.01; p=0.246). Overall survival rate was 96.1% (95% confidence interval [CI]: 93-98), 81.8% (95% CI: 77-86), and 45.5% (95% CI: 38-53) at 1, 5, and 10 years, respectively (p=0.236). The overall stroke rate was 0.3% (freedom from stroke [FFS]: 99.7%; 95% CI: 98-100), 0.9% (FFS: 99%; 95% CI: 98-100), and 4.3% (FFS: 95.7%; 95% CI: 89-98; M: n=6; F: n=2; p=0.774). Stroke-related mortality rate was 0.7% (FFS: 99.3%; 95% CI: 97-100) and 2.9% (FFS: 97.1%; 95% CI: 91-99) at 5 and 10 years, respectively, without differences between the groups (M: n=4; F: n=2; p=0.763). Overall FFR rate was 97.4% (95% CI: 95-99), 93.4% (95% CI: 90-96), and 89.5% (95% CI: 84-93; p=0.322). Two severe symptomatic restenosis (>70%, M) required a new endovascular revascularization.

Conclusion: The sex variable does not influence outcomes of CAS in asymptomatic patients at short- and long-term follow-up, although females show a worst incidence of periprocedural major strokes. Carotid artery stenting may be safely proposed when a careful patient selection is applied.Clinical ImpactThe sex variable has been advocated as a considerable factor that could influence the outcomes of transfemoral carotid artery stenting (CAS). Literature data are contrasting, even if different papers mainly reported that CAS is associated to worst outcomes in female patients. Our study shows that the sex-variable does not influence outcomes of CAS in asymptomatic patients at short and long-term follow-up, although females had a worst incidence of periprocedural major strokes. CAS may be safely proposed when a careful patient selection is applied.

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无症状患者行颈动脉支架植入术的性别相关结局。
目的:探讨性别对无症状患者行颈动脉支架植入术(CAS)的影响。材料和方法:2006年1月至2020年12月进行回顾性观察性研究。共有438例连续无症状颈动脉狭窄>70%的患者接受了经股动脉CAS,并分为男性(M)和女性(F)。围手术期30天的结局为:卒中、死亡和心肌梗死(MI)。随访结果为:死亡和卒中发生率(主要)、再狭窄自由度(FFR)和再干预率(次要)。随访数据分别在1年、5年和10年进行分析。资料采用χ2检验和Fisher精确检验分析,随访结果采用Kaplan-Meier曲线分析。对数秩检验用于确定组间差异,单变量分析用于确定危险因素和术中细节与死亡率和再狭窄率之间的关系。结果:共行462例(M: n=321例,占69.4%),其中双侧24例(5.5%)。平均年龄71.9±7.6岁(男:72.1±7.8岁;F: 71.7±7.3)。围手术期结果为:卒中发生率2.2% (n=10);M: n=5, 1.6%;F: n=5, 3.5%;p=0.176),死亡率0.6% (M: n=3, p=0.334),卒中/死亡率2.8% (n=13;M: n=8, 2.5%;F: n=5, 3.5%;p = 0.528);无心脏事件(MI)记录。3例男性(0.9%)发生非致残性(轻微)卒中,7例(1.7%)发生致残性(严重)卒中,其中5例为缺血性事件(M: n=2, 0.6%;F: n=3, 2.2%), 2例为脑出血(F: 1.3%, p=0.046)。平均随访73.66±40.83个月(M: 72.66;F: 76.01;p = 0.246)。1年、5年和10年的总生存率分别为96.1%(95%可信区间[CI]: 93-98)、81.8% (95% CI: 77-86)和45.5% (95% CI: 38-53) (p=0.236)。总卒中率为0.3%(无卒中[FFS]: 99.7%;95% ci: 98-100), 0.9% (off: 99%;95% CI: 98-100)和4.3% (FFS: 95.7%;95% ci: 89-98;M: n = 6;F: n = 2;p = 0.774)。卒中相关死亡率为0.7% (FFS: 99.3%;95% CI: 97-100)和2.9% (FFS: 97.1%;95% CI: 91-99),分别在5年和10年,组间无差异(M: n=4;F: n = 2;p = 0.763)。总体FFR率分别为97.4% (95% CI: 95-99)、93.4% (95% CI: 90-96)和89.5% (95% CI: 84-93;p = 0.322)。2例严重症状性再狭窄(>70%,M)需要进行新的血管内重建术。结论:在短期和长期随访中,性别变量不影响无症状患者CAS的预后,尽管女性在围手术期大卒中的发生率最高。颈动脉支架植入术可以在仔细选择患者的情况下安全地进行。临床影响:性别变量被认为是影响经股颈动脉支架植入术(CAS)结果的一个重要因素。尽管不同的论文主要报道了CAS与女性患者的最差预后相关,但文献数据却存在差异。我们的研究表明,性别变量并不影响无症状患者在短期和长期随访时的预后,尽管女性在围手术期大卒中的发生率最高。当仔细选择患者时,可以安全地提出CAS。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
期刊最新文献
Effects of Iliac Tortuosity Index on Fenestrated Endovascular Aortic Aneurysm Repair for Pararenal and Thoracoabdominal Aortic Aneurysms. Pulsatile Changes of the Aortic Diameter May Be Irrelevant Regarding Endograft Sizing in Patients With Aortic Disease. The Association Between the D-dimer Level at 1 Year After EVAR and Sac Diameter Change in Patients With Persistent Type 2 Endoleak. Sex-Related Outcomes in Asymptomatic Patients Undergoing Carotid Artery Stenting. Novel Surgeon-Modified Fenestrated Iliac Stent Graft.
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