颈动脉内膜切除术患者围手术期卒中发生率与指标症状及时间的关系

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-26 DOI:10.1016/j.jstrokecerebrovasdis.2025.108441

Rodolfo Pini , Gianluca Faggioli , Gert J de Borst , Marcello Lodato , Andrea Vacirca , Gemmi Sufali , Enrico Gallitto , Cristina Rocchi , Mauro Gargiulo

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引用次数: 0

摘要

背景与目的在症状性颈动脉狭窄（SCS）患者行颈动脉内膜切除术（CEA）可能由于疾病严重程度或出血转化而有较高的围手术期卒中风险。本研究旨在评估SCS的CEA结果，并根据干预时间和术前症状检查术后卒中的原因。方法分析2012 ~ 2023年两所城市医院收治的所有SCS的cea。在全麻、补片和分流的情况下进行cea。术后（30天）卒中分为技术性卒中、出血性卒中或栓塞性卒中，并通过时间（48小时、48小时- 2周、2周）和术前症状（TIA/烟性黑朦、轻微卒中、中重度卒中、逐渐加重的TIA/卒中）进行评估。采用改良Rankin量表（mRS）评估脑卒中严重程度。结果664例cea患者术后卒中发生率为3.0%。时间对卒中发生率有显著影响：48小时5.7%，48小时- 2周4.0%，2周1.4% （P = 0.04）。术前症状也影响卒中发生率，随着tia /卒中的发展，发生率最高（7.5%,P = 0.02）。早期CEA（48小时）独立增加卒中风险（优势比5.6,P = .04），出血性卒中与48小时干预相关（P = .005）。1.1%的病例发生严重中风，与术前症状有关（P = 0.05），但与干预时间无关。结论scea患者的卒中风险总体上是可接受的，但早期干预（48 h）会增加出血性卒中风险。在进化过程中，TIA/中风渐强后发生大中风的频率更高，与时间无关。

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Association between index symptom and timing on perioperative stroke rate in patients undergoing carotid endarterectomy

Background and Purpose

Carotid endarterectomy (CEA) in symptomatic carotid stenosis (SCS) may have a higher risk of perioperative stroke due to disease severity or hemorrhagic conversion. This study aimed to evaluate CEA outcomes for SCS and examine causes of post-operative stroke based on intervention timing and preoperative symptoms.

Methods

All CEAs performed for SCS from 2012 to 2023 across two metropolitan hospitals were analyzed. CEAs were performed with general anesthesia, patching, and shunting. Post-operative (30-day) strokes were classified as technical, hemorrhagic, or embolic and were evaluated by timing (<48 h, 48h–2 weeks, >2 weeks) and preoperative symptoms (TIA/amaurosis fugax, minor stroke, moderate-severe stroke, crescendo TIAs/stroke in evolution). Stroke severity was assessed using the modified Rankin Scale (mRS).

Results

Among 664 CEAs, post-operative stroke occurred in 3.0 % of cases. Timing significantly influenced stroke rates: 5.7 % <48 h, 4.0 % between 48h–2 weeks, and 1.4 % >2 weeks (P = .04). Preoperative symptoms also affected stroke rates, with highest rates following crescendo TIAs/stroke in evolution (7.5 %, P = .02). Early CEA (<48 h) independently increased stroke risk (odds ratio 5.6, P = .04), and hemorrhagic strokes were associated with <48 h interventions (P = .005). Major strokes occurred in 1.1 % of cases, linked to preoperative symptoms (P = .05), but not intervention timing.

Conclusions

CEA for SCS carries an acceptable stroke risk overall, though early intervention (<48 h) increases hemorrhagic stroke risk. Major strokes are more frequent following crescendo TIA/stroke in evolution, with no association to timing.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.