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：

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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.	邱衛紅, 彭立悅, 孫建萍. 92 例頸動脈內膜剝脫術后患者的護理體會. 心肺血管病雜志, 2015, 34(4): 307-309.
2.	高晨琛, 豐育功, 李環廷, 等. 頸動脈內膜剝脫術治療頸動脈狹窄(附 40 例臨床分析). 中國現代手術學雜志, 2015, 19(6): 431-435.
3.	Taboada CR, Duran Mari?o 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.	李福榮, 張美艷, 解麗麗, 等. 經顱多普勒超聲在頸動脈內膜剝脫術中的應用價值探討. 中華神經醫學雜志, 2014, 13(11): 1143-1146.
7.	樸成浩, 譚力力, 尹華石, 等. 血管超聲與 64 排螺旋 CT 血管造影在評價頸動脈狹窄中的對比研究. 現代生物醫學進展, 2017, 17(3): 523-525.
8.	王莉. 血管超聲與腦血管造影診斷頸動脈狹窄的對比分析. 中國實用醫藥, 2016, 11(1): 36-37.
9.	彭濤, 李尚喜, 劉茂元, 等. 彩色多普勒超聲及血管造影對頸動脈狹窄或閉塞患者的診斷價值. 中華醫學超聲雜志: 電子版, 2015, 12(4): 278-282.
10.	袁超, 劉亞麗, 呂茜. 頸動脈狹窄的超聲篩查及分析. 河北醫科大學學報, 2017, 38(1): 99-102.
11.	譚瑤. 彩色多普勒超聲與 DSA 診斷缺血性腦血管病患者顱外段頸動脈狹窄的對照研究. 河北醫學, 2016, 22(5): 708-711.
12.	張萌, 郝繼恒, 張利勇, 等. 頸動脈內膜剝脫術治療高齡頸動脈窄患者效果分析. 山東醫藥, 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.	陳宇, 劉昌偉, 劉志麗, 等. 頸動脈內膜剝脫術和頸動脈支架的療效分析. 中國卒中雜志, 2016, 11(7): 536-541.
15.	陳莉, 秦超, 莫雪安, 等. 頸動脈內膜剝脫術與頸動脈支架術的療效及安全性的比較. 中風與神經疾病雜志, 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.	陳東, 焦力群, 王繼躍, 等. 頸動脈內膜切除術治療頸動脈狹窄有效性及安全性的多中心研究. 中國腦血管病雜志, 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, 郭書英, 王穎, 等. 超敏 C 反應蛋白、同型半胱氨酸在急性腦梗死患者血清中的水平及其與頸動脈狹窄的相關性研究. 腦與神經疾病雜志, 2016, 24(4): 213-216.
24.	毛辰波, 王俊青. 急性腦梗死患者血清 NSE、hs-CRP 和 D-D 水平的臨床觀察. 健康研究, 2017, 37(1): 83-84.
25.	丁培源, 張文川. 血清同型半胱氨酸水平與無癥狀中度頸動脈狹窄患者發生斑塊相關腦血管事件相關性研究. 臨床軍醫雜志, 2017, 45(11): 1176-1177, 1179.

1. 邱衛紅, 彭立悅, 孫建萍. 92 例頸動脈內膜剝脫術后患者的護理體會. 心肺血管病雜志, 2015, 34(4): 307-309.
2. 高晨琛, 豐育功, 李環廷, 等. 頸動脈內膜剝脫術治療頸動脈狹窄(附 40 例臨床分析). 中國現代手術學雜志, 2015, 19(6): 431-435.
3. Taboada CR, Duran Mari?o 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. 李福榮, 張美艷, 解麗麗, 等. 經顱多普勒超聲在頸動脈內膜剝脫術中的應用價值探討. 中華神經醫學雜志, 2014, 13(11): 1143-1146.
7. 樸成浩, 譚力力, 尹華石, 等. 血管超聲與 64 排螺旋 CT 血管造影在評價頸動脈狹窄中的對比研究. 現代生物醫學進展, 2017, 17(3): 523-525.
8. 王莉. 血管超聲與腦血管造影診斷頸動脈狹窄的對比分析. 中國實用醫藥, 2016, 11(1): 36-37.
9. 彭濤, 李尚喜, 劉茂元, 等. 彩色多普勒超聲及血管造影對頸動脈狹窄或閉塞患者的診斷價值. 中華醫學超聲雜志: 電子版, 2015, 12(4): 278-282.
10. 袁超, 劉亞麗, 呂茜. 頸動脈狹窄的超聲篩查及分析. 河北醫科大學學報, 2017, 38(1): 99-102.
11. 譚瑤. 彩色多普勒超聲與 DSA 診斷缺血性腦血管病患者顱外段頸動脈狹窄的對照研究. 河北醫學, 2016, 22(5): 708-711.
12. 張萌, 郝繼恒, 張利勇, 等. 頸動脈內膜剝脫術治療高齡頸動脈窄患者效果分析. 山東醫藥, 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. 陳宇, 劉昌偉, 劉志麗, 等. 頸動脈內膜剝脫術和頸動脈支架的療效分析. 中國卒中雜志, 2016, 11(7): 536-541.
15. 陳莉, 秦超, 莫雪安, 等. 頸動脈內膜剝脫術與頸動脈支架術的療效及安全性的比較. 中風與神經疾病雜志, 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. 陳東, 焦力群, 王繼躍, 等. 頸動脈內膜切除術治療頸動脈狹窄有效性及安全性的多中心研究. 中國腦血管病雜志, 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, 郭書英, 王穎, 等. 超敏 C 反應蛋白、同型半胱氨酸在急性腦梗死患者血清中的水平及其與頸動脈狹窄的相關性研究. 腦與神經疾病雜志, 2016, 24(4): 213-216.
24. 毛辰波, 王俊青. 急性腦梗死患者血清 NSE、hs-CRP 和 D-D 水平的臨床觀察. 健康研究, 2017, 37(1): 83-84.
25. 丁培源, 張文川. 血清同型半胱氨酸水平與無癥狀中度頸動脈狹窄患者發生斑塊相關腦血管事件相關性研究. 臨床軍醫雜志, 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

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