颈动脉内膜剥脱术中选择性分流术后的短期疗效:倾向评分匹配分析

IF 0.7 4区 医学 Q4 NEUROSCIENCES
Juliana Pereira-Macedo , Luís Afonso Fialho Duarte-Gamas , António Henrique Pereira-Neves , José Paulo Alves Vieira de Andrade , João Manuel Palmeira Rocha-Neves
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引用次数: 0

摘要

导言和目的 颈动脉内膜剥脱术中的颈动脉交叉钳夹可能导致术中神经功能缺损,增加卒中/死亡风险。如果发现神经功能缺损,建议进行颈动脉分流以降低中风风险。然而,分流可能会维持栓塞事件的特定几率,进而造成伤害。目前的证据对分流的明显益处仍有疑问。材料和方法从 2013 年 1 月至 2021 年 5 月,检索了所有在区域麻醉下接受颈动脉内膜切除术且术中出现神经系统改变的患者。将接受选择性分流术的患者与未接受分流术的患者进行比较。进行了 1:1 倾向评分匹配(PSM)。通过单变量分析,计算了组间差异和临床结果。在 PSM 之后,22 名非分流患者与 22 名匹配的分流患者进行了比较。在人口统计学和合并症方面,两组患者在分流前和分流后的情况相当,但慢性心力衰竭除外,在分流前的分析中,分流患者的慢性心力衰竭发生率更高(26.1%,P = 0.036)。关于 30 天卒中和 Clavien-Dindo 评分≥ 2,未发现明显关联(P = 0.730、P = 0.635 和 P = 0.942、P = 0.472,PSM 前和 PSM 后相应)。尽管如此,还必须进行更多更广泛的研究,才能得出准确的结果,说明颈动脉分流术在区域麻醉下的这部分患者中的确切效用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Short-term outcomes after selective shunt during carotid endarterectomy: A propensity score matching analysis

Introduction and objectives

Carotid cross-clamping during carotid endarterectomy might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy.

Material and methods

From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 propensity score matching (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis.

Results

Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, P = 0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien–Dindo  2, no significant association was found (P = 0.730, P = 0.635 and P = 0.942, P = 0.472, correspondingly, for pre and post-PSM).

Conclusions

In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien–Dindo  2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia.

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来源期刊
Neurocirugia
Neurocirugia 医学-神经科学
CiteScore
1.30
自引率
0.00%
发文量
67
审稿时长
60 days
期刊介绍: Neurocirugía is the official Journal of the Spanish Society of Neurosurgery (SENEC). It is published every 2 months (6 issues per year). Neurocirugía will consider for publication, original clinical and experimental scientific works associated with neurosurgery and other related neurological sciences. All manuscripts are submitted for review by experts in the field (peer review) and are carried out anonymously (double blind). The Journal accepts works written in Spanish or English.
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