Analysis on Effectiveness and Safety of The Carotid Endarterectomy in Treating Elderly Patients with Carotid Artery Stenosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DIAOYong-peng , LIUChang-wei , SONGXiao-jun , GUOLi-long ,  LIYong-jun , CHENYue-xin , LIANLi-shan , ZHENGYue-hong , YEWei , LIUBao

Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China;

Corresponding author：

LIYong-jun, Email: yongj_93@hotmail.com

Keywords：

Carotid artery stenosis; Endarterectomy; Carotid artery; Advanced age; Complication; Risk factor

DOI：

10.7507/1007-9424.20140012

Video：

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Objective To summarize the experience in treating the elderly patients (≥75 years old) with carotid artery stenosis, and to evaluate the efficacy and safety of the carotid endarterectomy (CEA). Methods The datum of 312 cases with carotid artery stenosis and underwent the CEA in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were retrospectively analized.The risk factors of the CEA in treating the elderly patients were analized, and the measures to prevent perioperative complications were discussed. Results Thirty-nine cases were brought into the research.The mean follow-up was (22.18±8.71) months.Thirty-three cases (84.6%) were male and 6 cases (15.4%) were female.The median age was 77 years old (75-82 years old).Eleven cases (28.2%) were with bilateral lesions, and 7 cases (17.9%) were asymptomatic.A total of 39 CEA procedures were successfully performed, 22 artificial vascular patches (56.4%) and 16 shunts (41.0%) were used.The mean average hospital stay was (17.38±5.39) days.One case showed cerebral hyperperfusion syndrome in 2th day after operation, another 1 case was found ipsilateral restenosis in 15th month after operation. Conclusion CEA is a safe and effective measure in treating the elderly patients with carotid artery stenosis, if the the indications of surgery is performed strictly.

Citation： DIAOYong-peng, LIUChang-wei, SONGXiao-jun, GUOLi-long, LIYong-jun, CHENYue-xin, LIANLi-shan, ZHENGYue-hong, YEWei, LIUBao. Analysis on Effectiveness and Safety of The Carotid Endarterectomy in Treating Elderly Patients with Carotid Artery Stenosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(1): 60-64. doi: 10.7507/1007-9424.20140012 Copy

1.	SPACE Collaborative Group.30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients:a randomized non-inferiority trial[J].Lancet, 2006, 368(9543):1239-1247.
2.	Mas JL, Chatellier G, Beyssen B, et al.Endarterectomy versus stentingin patients with symptomatic severe carotid stenosis[J].N Engl J Med, 2006, 355(16):1660-1671.
3.	Liapis CD, Bell PR, Mikhailidis D, et al.ESVS guidelines.Inv-asive treatment for carotid stenosis:indications, techniques[J].Eur J Vasc Endovasc Surg, 2009, 37(4 Suppl):1-19.
4.	North American Symptomatic Carotid Endarterectomy Trial Colla-borators.Beneficial effect of carotid endarterectomy in sympto-matic patients with high-grade carotid stenosis[J].N Engl J Med, 1991, 325(7):445-453.
5.	陈宇, 吴巍巍, 刘暴, 等.颈动脉内膜剥脱术在双侧颈动脉中、重度狭窄患者治疗中的应用[J].中国医学科学院学报, 2010, 32(5):565-568.
6.	Timaran CH, Mantese VA, Malas M, et al.Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the carotid revascularization endarterectomy versus stenting trial (CREST)[J].J Vasc Surg, 2013, 57(2):303-308.
7.	Mcclelland S 3rd.Multimodality management of carotidartery stenosis:reviewing the class-Ievidence[J].J Natl Med Assoc, 2007, 99(11):1235-1242.
8.	韩伟, 符伟国, 王玉琦, 等.高危颈动脉狭窄患者的外科治疗(附24例报告)[J].中国普外基础与临床杂志, 2004, 11(4):304-306.
9.	Yadav JS, Wholey MH, Kuntz RE, et al.Protected carotid-artery stenting versus endarterectomy in high-risk patients[J].N Engl J Med, 2004, 351(15):1493-1501.
10.	Ballotta E, Da Giau G, Militello C, et al.High-grade symptomatic and asymptomatic carotid stenosis in the very elderly.A challenge for proponents ofcarotid angioplasty and stenting[J].BMC Cardiovasc Disord, 2006, 6:12.
11.	Reed AB, Gaccione P, Belkin M, et al.Preoperative risk factors for carotid endarterectomy:defining the patient at high risk[J].J VascSurg, 2003, 37(6):1191-1199.
12.	Voeks JH, Howard G, Roubin GS, et al.Age and outcomes after carotid stentingand endarterectomy:the carotid revascularization endarterectomy versus stenting trial[J].Stroke, 2011, 42(12):3484-3490.
13.	GALA Trial Collaborative Group, Lewis SC, Warlow CP, et al.General anaesthesia versus local anaesthesia for carotid surgery (GALA):a multicentre, randomised controlled trial[J].Lancet, 2008, 372(9656):2132-2142.
14.	Stoner MC, Defreitas DJ.Process of care for carotid endarterec-tomy:perioperative medical management[J].J Vasc Surg, 2010, 52(1):223-231.
15.	Momin TA, Ricotta JJ.Minimizing the complications of carotid endarterectomy[J].Perspect Vasc Surg Endovasc Ther, 2010, 22(2):106-113.
16.	乔彤, 刘长建, 黄佃, 等.动脉内膜剥脱术治疗颈动脉狭窄179例临床分析[J].中国实用外科杂志, 2012, 32(8):659-661.
17.	刁永鹏, 刘昌伟, 宋小军, 等.两种颈动脉内膜剥脱术式治疗颈动脉狭窄的疗效分析[J].中华医学杂志, 2013, 93(27):2135-2138.
18.	Ogasawara K, Yukawa H, Kobayashi M, et al.Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning[J].J Neurosurg, 2003, 99(3):504-510.
19.	Ogasawara K, Mikami C, Inoue T, et al.Delayed cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy:case report[J].Neurosurgery, 2004, 54(5):1258-1261.
20.	陈宇, 吴巍巍, 刘暴, 等.颈动脉内膜剥脱术后过度灌注综合征[J].中国卒中杂志, 2010, 5(4):338-342.
21.	倪冷, 刘昌伟, 刘暴, 等.颈动脉转流管对预防颈动脉内膜剥脱术后脑过度灌注综合征的预防作用[J].中华医学杂志, 2013, 93(15):1142-1145.
22.	Lieb M, Shah U, Hines GL.Cerebral hyperperfusion syndrome after carotid intervention:a review[J].Cardiol Rev, 2012, 20(2):84-89.
23.	Kim KH, Lee CH, Son YJ, et al.Post-carotid endarterectomy cerebral hyperperfusion syndrome:is it preventable by strict blood pressure control?[J].J Korean Neurosurg Soc, 2013, 54(3):159-163.
24.	郭建明, 谷涌泉, 李学峰, 等.脑过度灌注综合征的临床进展[J].中华医学杂志, 2012, 92(21):1508-1510.
25.	刘暴, 来志超, 倪冷, 等.经颅多普勒超声预警颈动脉内膜切除术后脑高灌注综合征[J].中华外科杂志, 2013, 51(6):504-507.

1. SPACE Collaborative Group.30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients:a randomized non-inferiority trial[J].Lancet, 2006, 368(9543):1239-1247.
2. Mas JL, Chatellier G, Beyssen B, et al.Endarterectomy versus stentingin patients with symptomatic severe carotid stenosis[J].N Engl J Med, 2006, 355(16):1660-1671.
3. Liapis CD, Bell PR, Mikhailidis D, et al.ESVS guidelines.Inv-asive treatment for carotid stenosis:indications, techniques[J].Eur J Vasc Endovasc Surg, 2009, 37(4 Suppl):1-19.
4. North American Symptomatic Carotid Endarterectomy Trial Colla-borators.Beneficial effect of carotid endarterectomy in sympto-matic patients with high-grade carotid stenosis[J].N Engl J Med, 1991, 325(7):445-453.
5. 陈宇, 吴巍巍, 刘暴, 等.颈动脉内膜剥脱术在双侧颈动脉中、重度狭窄患者治疗中的应用[J].中国医学科学院学报, 2010, 32(5):565-568.
6. Timaran CH, Mantese VA, Malas M, et al.Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the carotid revascularization endarterectomy versus stenting trial (CREST)[J].J Vasc Surg, 2013, 57(2):303-308.
7. Mcclelland S 3rd.Multimodality management of carotidartery stenosis:reviewing the class-Ievidence[J].J Natl Med Assoc, 2007, 99(11):1235-1242.
8. 韩伟, 符伟国, 王玉琦, 等.高危颈动脉狭窄患者的外科治疗(附24例报告)[J].中国普外基础与临床杂志, 2004, 11(4):304-306.
9. Yadav JS, Wholey MH, Kuntz RE, et al.Protected carotid-artery stenting versus endarterectomy in high-risk patients[J].N Engl J Med, 2004, 351(15):1493-1501.
10. Ballotta E, Da Giau G, Militello C, et al.High-grade symptomatic and asymptomatic carotid stenosis in the very elderly.A challenge for proponents ofcarotid angioplasty and stenting[J].BMC Cardiovasc Disord, 2006, 6:12.
11. Reed AB, Gaccione P, Belkin M, et al.Preoperative risk factors for carotid endarterectomy:defining the patient at high risk[J].J VascSurg, 2003, 37(6):1191-1199.
12. Voeks JH, Howard G, Roubin GS, et al.Age and outcomes after carotid stentingand endarterectomy:the carotid revascularization endarterectomy versus stenting trial[J].Stroke, 2011, 42(12):3484-3490.
13. GALA Trial Collaborative Group, Lewis SC, Warlow CP, et al.General anaesthesia versus local anaesthesia for carotid surgery (GALA):a multicentre, randomised controlled trial[J].Lancet, 2008, 372(9656):2132-2142.
14. Stoner MC, Defreitas DJ.Process of care for carotid endarterec-tomy:perioperative medical management[J].J Vasc Surg, 2010, 52(1):223-231.
15. Momin TA, Ricotta JJ.Minimizing the complications of carotid endarterectomy[J].Perspect Vasc Surg Endovasc Ther, 2010, 22(2):106-113.
16. 乔彤, 刘长建, 黄佃, 等.动脉内膜剥脱术治疗颈动脉狭窄179例临床分析[J].中国实用外科杂志, 2012, 32(8):659-661.
17. 刁永鹏, 刘昌伟, 宋小军, 等.两种颈动脉内膜剥脱术式治疗颈动脉狭窄的疗效分析[J].中华医学杂志, 2013, 93(27):2135-2138.
18. Ogasawara K, Yukawa H, Kobayashi M, et al.Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning[J].J Neurosurg, 2003, 99(3):504-510.
19. Ogasawara K, Mikami C, Inoue T, et al.Delayed cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy:case report[J].Neurosurgery, 2004, 54(5):1258-1261.
20. 陈宇, 吴巍巍, 刘暴, 等.颈动脉内膜剥脱术后过度灌注综合征[J].中国卒中杂志, 2010, 5(4):338-342.
21. 倪冷, 刘昌伟, 刘暴, 等.颈动脉转流管对预防颈动脉内膜剥脱术后脑过度灌注综合征的预防作用[J].中华医学杂志, 2013, 93(15):1142-1145.
22. Lieb M, Shah U, Hines GL.Cerebral hyperperfusion syndrome after carotid intervention:a review[J].Cardiol Rev, 2012, 20(2):84-89.
23. Kim KH, Lee CH, Son YJ, et al.Post-carotid endarterectomy cerebral hyperperfusion syndrome:is it preventable by strict blood pressure control?[J].J Korean Neurosurg Soc, 2013, 54(3):159-163.
24. 郭建明, 谷涌泉, 李学峰, 等.脑过度灌注综合征的临床进展[J].中华医学杂志, 2012, 92(21):1508-1510.
25. 刘暴, 来志超, 倪冷, 等.经颅多普勒超声预警颈动脉内膜切除术后脑高灌注综合征[J].中华外科杂志, 2013, 51(6):504-507.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis on Effectiveness and Safety of The Carotid Endarterectomy in Treating Elderly Patients with Carotid Artery Stenosis

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