Eversion versus conventional carotid endarterectomy with patch angioplasty: Population-based cohort study.

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2025-09-18 DOI:10.1016/j.jvs.2025.09.029

Arnar B Ingason, Venkatesa P Muruganandam, Sean Liebscher, Daniel J Bertges, Georg Steinthorsson

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引用次数: 0

Abstract

Objective: To compare in-hospital and long-term outcomes between conventional carotid endarterectomy with patch angioplasty (cCEA) and eversion carotid endarterecomy (eCEA).

Methods: Patients undergoing eCEA or cCEA from 1 Jan 2012 to 31 December 2024 were identified using the Vascular Quality Initiative database and included in the study. Inverse probability weighting was used to yield balanced study groups. Propensity-weighted logistic regression was used to compare binary outcomes and propensity-weighted Cox regression to compare all-cause mortality.

Results: Overall, 157,729 patients undergoing cCEA and 22,296 patients undergoing eCEA were included in the study. eCEA was associated with lower odds of cranial nerve injury (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.66-0.73). This was consistent for injuries to cranial nerves VII, IX, X, XII, and other cranial nerves. Similarly, eCEA had lower odds of in-hospital myocardial infarction (aOR 0.71, 95% CI 0.65-0.78) and long-term myocardial infarction (aOR 0.92, 95% CI 0.87-0.98) compared to cCEA. The odds of in-hospital stroke or transient ischemic attack (aOR 1.06, 95% CI 0.99-1.12) and long-term stroke or transient ischemic attack (aOR 1.03, 95% CI 0.98-1.07) were similar in both groups. However, odds of in-hospital stroke (aOR 0.89, 95% CI 0.81-0.99) and long-term stroke (aOR 0.93, 95% CI 0.85-0.98) was lower for eCEA. All-cause mortality was similar in both groups (aOR 1.05, 95% CI 0.99-1.11). Patients that were younger, had higher BMI, underwent general anesthesia, and underwent surgery later in the study period were found to experience greater benefit from undergoing eCEA.

Conclusion: eCEA was associated with lower odds of stroke, cranial nerve injury, and myocardial infarction, but similar all-cause mortality rates compared to cCEA. Given its superior effectiveness and safety, eCEA may be a better alternative to cCEA for treatment of flow-limiting carotid disease.

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外翻与常规颈动脉内膜切除术贴片血管成形术：基于人群的队列研究。

目的：比较常规颈动脉内膜切除术联合膜片血管成形术（cCEA）和外翻颈动脉内膜切除术（eCEA）的住院和远期疗效。方法：2012年1月1日至2024年12月31日期间接受eCEA或cCEA的患者通过血管质量倡议数据库被识别并纳入研究。使用逆概率加权来产生平衡的研究组。采用倾向加权logistic回归比较二元结果，采用倾向加权Cox回归比较全因死亡率。结果：研究共纳入157729例cCEA患者和22296例eCEA患者。eCEA与颅神经损伤的发生率较低相关（调整优势比[aOR] 0.69, 95%可信区间[CI] 0.66-0.73）。这与脑神经VII、IX、X、XII和其他脑神经损伤是一致的。同样，与cCEA相比，eCEA发生院内心肌梗死（aOR 0.71, 95% CI 0.65-0.78）和长期心肌梗死（aOR 0.92, 95% CI 0.87-0.98）的几率较低。两组住院卒中或短暂性脑缺血发作（aOR 1.06, 95% CI 0.99-1.12）和长期卒中或短暂性脑缺血发作（aOR 1.03, 95% CI 0.98-1.07）的几率相似。然而，eCEA患者发生院内卒中（aOR 0.89, 95% CI 0.81-0.99）和长期卒中（aOR 0.93, 95% CI 0.85-0.98）的几率较低。两组的全因死亡率相似（aOR 1.05, 95% CI 0.99-1.11）。研究发现，年龄较小、BMI较高、接受全身麻醉以及在研究后期接受手术的患者从eCEA中获益更大。结论：eCEA与卒中、脑神经损伤和心肌梗死的发生率较低相关，但与cCEA相比全因死亡率相似。鉴于其优越的有效性和安全性，eCEA可能是cCEA治疗血流受限颈动脉疾病的更好选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.