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Stroke:颈动脉支架成形术和颈动脉内膜切除术后的围手术期心肌梗死

2015-08-19 崔倩 译 MedSci原创

    与颈动脉内膜切除术(CEA)相比,颈动脉支架成形术(CAS)增加了围手术期卒中和死亡的风险。相反,在随机试验中CEA后心肌梗死(MI)的风险要高于CAS后。但是,发生数量很少,而且风险因素是未知的。    研究人员进行了系统回顾和荟萃分析,从1980年1月至2014年6月公布的研究和未发表的研究中收集数据。研究人员对预定义的9个危险因素(年龄,对侧颈

与颈动脉内膜切除术(CEA)相比,颈动脉支架成形术(CAS)增加了围手术期卒中和死亡的风险。相反,在随机试验中CEA后心肌梗死(MI)的风险要高于CAS后。但是,发生数量很少,而且风险因素是未知的。

研究人员进行了系统回顾和荟萃分析,从1980年1月至2014年6月公布的研究和未发表的研究中收集数据。研究人员对预定义的9个危险因素(年龄,对侧颈动脉闭塞,冠状动脉疾病,糖尿病,性别,高血压,外周动脉疾病,狭窄类型和临床表现)提取数据。研究人员选择的研究中至少有一个亚组的MI数据可用,并计算绝对和相对的风险,并确定了MI风险的不同影响。

CAS后心肌梗死的30天绝对危险为0.87%(95%置信区间,0.69-1.07),CEA后的绝对风险为0.70%(95%置信区间,0.54-0.88)(P=0.38)。CAS后,有症状的狭窄和再狭窄的患者心肌梗死的风险较高,而男性的风险较低。CEA后,年龄、冠状动脉疾病史、外周动脉疾病和再狭窄增加了心肌梗死的风险。CAS和CEA之间的差异只有性别造成的影响,即CAS后男性处于MI比女性风险较低,然而CEA后性别间无差异(P=0.01)。

CEA和CAS后MI的风险并没有显著差异。MI的危险因素在两种技术中整体相似,唯一的的不同之处在于CAS后男性的心梗风险较低,而CEA后没有这种情况。

原始出处:

Marion Boulanger, MD, Lucie Camelière, MD, Rui Felgueiras, MD, Ludovic Berger, PhD, Kittipan Rerkasem, PhD, Peter M. Rothwell, PhD and Emmanuel Touzé, PhD,Periprocedural Myocardial Infarction After Carotid Endarterectomy and Stenting,Stroke,2015.8.18

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1708318, encodeId=024c1e083189d, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30515, encryptionId=4c2d3051535, topicName=内膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=730431558473, createdName=12498974m61暂无昵称, createdTime=Mon Dec 28 23:12:00 CST 2015, time=2015-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053732, encodeId=3d2a2053e32c3, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jul 17 23:12:00 CST 2016, time=2016-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2004633, encodeId=79e1200463354, content=<a href='/topic/show?id=4e8a5400816' target=_blank style='color:#2F92EE;'>#成形术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54008, encryptionId=4e8a5400816, topicName=成形术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Wed May 18 19:12:00 CST 2016, time=2016-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843391, encodeId=b0221843391d5, content=<a href='/topic/show?id=dab8100523bb' target=_blank style='color:#2F92EE;'>#颈动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100523, encryptionId=dab8100523bb, topicName=颈动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=416347, createdName=mhzhuang@stu.e, createdTime=Fri Jan 22 08:12:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1876707, encodeId=7d9818e67075a, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Wed Nov 11 21:12:00 CST 2015, time=2015-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1984464, encodeId=311d19844644b, content=<a href='/topic/show?id=5f7310054216' target=_blank style='color:#2F92EE;'>#颈动脉支架#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100542, encryptionId=5f7310054216, topicName=颈动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Wed Jan 27 21:12:00 CST 2016, time=2016-01-27, status=1, ipAttribution=)]
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