Short-term and long-term efficacy of carotid endarterectomy in patients with carotid artery stenosis and risk factors for occurrence of cardiovascular and cerebrovascular events_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FENG Tao , LI Jing , ZHENG Dianyu , PAN Jinqiang ,  GENG Zhongli

The Second Department of General Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi 830000, P. R. China;

Corresponding author：

GENG Zhongli, Email: Gengzhongli@medmail.com.cn

Keywords：

carotid artery stenosis; carotid endarterectomy; efficacy; cardiovascular and cerebrovascular event; risk factor

DOI：

10.7507/1007-9424.201905111

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the short-term and long-term efficacy of carotid endarterectomy (CEA) in patients with carotid artery stenosis, and analyze the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after operation.Methods The clinical data of 326 patients with carotid artery stenosis who underwent CEA in the Second Department of General Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University from January 2012 to December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to screen the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA, and the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of serum homocysteine (Hcy) and modified Rankin scale (mRS) score.Results All patients underwent successful surgery. Follow-up results showed that the incidence rate of cardiovascular and cerebrovascular events within 30 days after surgery was 6.7% (22/326), and the incidence rate of cardiovascular and cerebrovascular events within one year after surgery was 11.8% (38/323). Multivariate logistic regression analysis showed that smoking history (OR=2.373), contralateral carotid artery stenosis (OR=4.669), preoperative mRS score≥3 (OR=2.550), and preoperative serum Hcy≥20 μmmol/L (OR=1.335) were independent risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA (P<0.05). ROC curve analysis showed that the area under the curve of serum Hcy level was 0.834 in predicting cardiovascular and cerebrovascular events within 30 days after CEA [95%CI was (0.769, 0.899), P=0.003]. The area under the ROC curve of mRS score for predicting cardiovascular and cerebrovascular events within 30 days after CEA was 0.697 [95%CI was (0.552, 0.842), P=0.009].Conclusions CEA is a safe and effective procedure for the treatment of carotid artery stenosis. The smoking history, contralateral carotid artery stenosis, preoperative severe neurological deficit, and elevated serum Hcy are independent risk factors for occurrence of cardiovascular and cerebrovascular events after CEA.

Citation： FENG Tao, LI Jing, ZHENG Dianyu, PAN Jinqiang, GENG Zhongli. Short-term and long-term efficacy of carotid endarterectomy in patients with carotid artery stenosis and risk factors for occurrence of cardiovascular and cerebrovascular events. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 691-696. doi: 10.7507/1007-9424.201905111 Copy

1.	邱卫红, 彭立悦, 孙建萍. 92 例颈动脉内膜剥脱术后患者的护理体会. 心肺血管病杂志, 2015, 34(4): 307-309.
2.	高晨琛, 丰育功, 李环廷, 等. 颈动脉内膜剥脱术治疗颈动脉狭窄(附 40 例临床分析). 中国现代手术学杂志, 2015, 19(6): 431-435.
3.	Taboada CR, Duran Mariño JL, Garcia Colodro JM, et al. Clinical outcomes after carotid endarterectomy in patients with contralateral carotid occlusion. Ann Vasc Surg, 2016, 32: 83-87.
4.	Stoberock K, Debus ES, Atlihan G, et al. Gender differences in patients with carotid stenosis. Vasa, 2016, 45(1): 11-16.
5.	DE Waard DD, Morris D, DE Borst GJ, et al. Asymptomatic carotid artery stenosis: who should be screened, who should be treated and how should we treat them? J Cardiovasc Surg (Torino), 2017, 58(1): 3-12.
6.	李福荣, 张美艳, 解丽丽, 等. 经颅多普勒超声在颈动脉内膜剥脱术中的应用价值探讨. 中华神经医学杂志, 2014, 13(11): 1143-1146.
7.	朴成浩, 谭力力, 尹华石, 等. 血管超声与 64 排螺旋 CT 血管造影在评价颈动脉狭窄中的对比研究. 现代生物医学进展, 2017, 17(3): 523-525.
8.	王莉. 血管超声与脑血管造影诊断颈动脉狭窄的对比分析. 中国实用医药, 2016, 11(1): 36-37.
9.	彭涛, 李尚喜, 刘茂元, 等. 彩色多普勒超声及血管造影对颈动脉狭窄或闭塞患者的诊断价值. 中华医学超声杂志: 电子版, 2015, 12(4): 278-282.
10.	袁超, 刘亚丽, 吕茜. 颈动脉狭窄的超声筛查及分析. 河北医科大学学报, 2017, 38(1): 99-102.
11.	谭瑶. 彩色多普勒超声与 DSA 诊断缺血性脑血管病患者颅外段颈动脉狭窄的对照研究. 河北医学, 2016, 22(5): 708-711.
12.	张萌, 郝继恒, 张利勇, 等. 颈动脉内膜剥脱术治疗高龄颈动脉窄患者效果分析. 山东医药, 2016, 56(14): 18-20.
13.	Jim J, Rubin BG, Ricotta JJ 2nd, et al . Society for Vascular Surgery (SVS) Vascular Registry evaluation of comparative effectiveness of carotid revascularization procedures stratified by medicare age. J Vasc Surg, 2012, 55(5): 1313-1320.
14.	陈宇, 刘昌伟, 刘志丽, 等. 颈动脉内膜剥脱术和颈动脉支架的疗效分析. 中国卒中杂志, 2016, 11(7): 536-541.
15.	陈莉, 秦超, 莫雪安, 等. 颈动脉内膜剥脱术与颈动脉支架术的疗效及安全性的比较. 中风与神经疾病杂志, 2014, 31(1): 29-31.
16.	Lal BK, Beach KW, Roubin GS, et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol, 2012, 11(9): 755-763.
17.	Kragsterman B, Logason K, Ahari A, et al. Risk factors for complications after carotid endarterectomy-a population-based study. Eur J Vasc Endovasc Surg, 2004, 28(1): 98-103.
18.	Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med, 2004, 351(15): 1493-1501.
19.	Faggioli G, Pini R, Mauro R, et al. Contralateral carotid occlusion in endovascular and surgical carotid revascularization: a single centre experience with literature review and meta-analysis. Eur J Vasc Endovasc Surg, 2013, 46(1): 10-20.
20.	Halm EA, Hannan EL, Rojas M, et al. Clinical and operative predictors of outcomes of carotid endarterectomy. J Vasc Surg, 2005, 42(3): 420-428.
21.	陈东, 焦力群, 王继跃, 等. 颈动脉内膜切除术治疗颈动脉狭窄有效性及安全性的多中心研究. 中国脑血管病杂志, 2013, 10(9): 452-457.
22.	Skagen K, Skjelland M, Zamani M, et al. Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment. Croat Med J, 2016, 57(4): 311-320.
23.	王廉昌, 郭书英, 王颖, 等. 超敏 C 反应蛋白、同型半胱氨酸在急性脑梗死患者血清中的水平及其与颈动脉狭窄的相关性研究. 脑与神经疾病杂志, 2016, 24(4): 213-216.
24.	毛辰波, 王俊青. 急性脑梗死患者血清 NSE、hs-CRP 和 D-D 水平的临床观察. 健康研究, 2017, 37(1): 83-84.
25.	丁培源, 张文川. 血清同型半胱氨酸水平与无症状中度颈动脉狭窄患者发生斑块相关脑血管事件相关性研究. 临床军医杂志, 2017, 45(11): 1176-1177, 1179.

1. 邱卫红, 彭立悦, 孙建萍. 92 例颈动脉内膜剥脱术后患者的护理体会. 心肺血管病杂志, 2015, 34(4): 307-309.
2. 高晨琛, 丰育功, 李环廷, 等. 颈动脉内膜剥脱术治疗颈动脉狭窄(附 40 例临床分析). 中国现代手术学杂志, 2015, 19(6): 431-435.
3. Taboada CR, Duran Mariño JL, Garcia Colodro JM, et al. Clinical outcomes after carotid endarterectomy in patients with contralateral carotid occlusion. Ann Vasc Surg, 2016, 32: 83-87.
4. Stoberock K, Debus ES, Atlihan G, et al. Gender differences in patients with carotid stenosis. Vasa, 2016, 45(1): 11-16.
5. DE Waard DD, Morris D, DE Borst GJ, et al. Asymptomatic carotid artery stenosis: who should be screened, who should be treated and how should we treat them? J Cardiovasc Surg (Torino), 2017, 58(1): 3-12.
6. 李福荣, 张美艳, 解丽丽, 等. 经颅多普勒超声在颈动脉内膜剥脱术中的应用价值探讨. 中华神经医学杂志, 2014, 13(11): 1143-1146.
7. 朴成浩, 谭力力, 尹华石, 等. 血管超声与 64 排螺旋 CT 血管造影在评价颈动脉狭窄中的对比研究. 现代生物医学进展, 2017, 17(3): 523-525.
8. 王莉. 血管超声与脑血管造影诊断颈动脉狭窄的对比分析. 中国实用医药, 2016, 11(1): 36-37.
9. 彭涛, 李尚喜, 刘茂元, 等. 彩色多普勒超声及血管造影对颈动脉狭窄或闭塞患者的诊断价值. 中华医学超声杂志: 电子版, 2015, 12(4): 278-282.
10. 袁超, 刘亚丽, 吕茜. 颈动脉狭窄的超声筛查及分析. 河北医科大学学报, 2017, 38(1): 99-102.
11. 谭瑶. 彩色多普勒超声与 DSA 诊断缺血性脑血管病患者颅外段颈动脉狭窄的对照研究. 河北医学, 2016, 22(5): 708-711.
12. 张萌, 郝继恒, 张利勇, 等. 颈动脉内膜剥脱术治疗高龄颈动脉窄患者效果分析. 山东医药, 2016, 56(14): 18-20.
13. Jim J, Rubin BG, Ricotta JJ 2nd, et al . Society for Vascular Surgery (SVS) Vascular Registry evaluation of comparative effectiveness of carotid revascularization procedures stratified by medicare age. J Vasc Surg, 2012, 55(5): 1313-1320.
14. 陈宇, 刘昌伟, 刘志丽, 等. 颈动脉内膜剥脱术和颈动脉支架的疗效分析. 中国卒中杂志, 2016, 11(7): 536-541.
15. 陈莉, 秦超, 莫雪安, 等. 颈动脉内膜剥脱术与颈动脉支架术的疗效及安全性的比较. 中风与神经疾病杂志, 2014, 31(1): 29-31.
16. Lal BK, Beach KW, Roubin GS, et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol, 2012, 11(9): 755-763.
17. Kragsterman B, Logason K, Ahari A, et al. Risk factors for complications after carotid endarterectomy-a population-based study. Eur J Vasc Endovasc Surg, 2004, 28(1): 98-103.
18. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med, 2004, 351(15): 1493-1501.
19. Faggioli G, Pini R, Mauro R, et al. Contralateral carotid occlusion in endovascular and surgical carotid revascularization: a single centre experience with literature review and meta-analysis. Eur J Vasc Endovasc Surg, 2013, 46(1): 10-20.
20. Halm EA, Hannan EL, Rojas M, et al. Clinical and operative predictors of outcomes of carotid endarterectomy. J Vasc Surg, 2005, 42(3): 420-428.
21. 陈东, 焦力群, 王继跃, 等. 颈动脉内膜切除术治疗颈动脉狭窄有效性及安全性的多中心研究. 中国脑血管病杂志, 2013, 10(9): 452-457.
22. Skagen K, Skjelland M, Zamani M, et al. Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment. Croat Med J, 2016, 57(4): 311-320.
23. 王廉昌, 郭书英, 王颖, 等. 超敏 C 反应蛋白、同型半胱氨酸在急性脑梗死患者血清中的水平及其与颈动脉狭窄的相关性研究. 脑与神经疾病杂志, 2016, 24(4): 213-216.
24. 毛辰波, 王俊青. 急性脑梗死患者血清 NSE、hs-CRP 和 D-D 水平的临床观察. 健康研究, 2017, 37(1): 83-84.
25. 丁培源, 张文川. 血清同型半胱氨酸水平与无症状中度颈动脉狭窄患者发生斑块相关脑血管事件相关性研究. 临床军医杂志, 2017, 45(11): 1176-1177, 1179.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Short-term and long-term efficacy of carotid endarterectomy in patients with carotid artery stenosis and risk factors for occurrence of cardiovascular and cerebrovascular events

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content