缺血性脑卒中不同时期颈动脉内膜切除术的近期和远期效果

I.P.Pavlov Russian Medical Biological Herald Pub Date : 2020-10-19 DOI:10.23888/pavlovj2020283312-322

A. Kazantsev, K. Chernykh, N. Zarkua, R. Lider, E. Burkova, G. Bagdavadze, E. Y. Kalinin, T. E. Zaitseva, A. E. Chikin, Y. Linets, K. Kubachev

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Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1 st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2 nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3 rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4 th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months. Results . In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р 1-2 =0.01; р 1-3 =0.009; р 1-4 =0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р 1-2 =0.002; р 1-3 =0.008; р 2-4 =0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р 1-2 =0.0001; р 1-3 =0.0001; р 1-4 =0.005; р 2-4 =0.0006; р 3-4 =0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.","PeriodicalId":13184,"journal":{"name":"I.P.Pavlov Russian Medical Biological Herald","volume":"264 1","pages":"312-322"},"PeriodicalIF":0.0000,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"4","resultStr":"{\"title\":\"Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke\",\"authors\":\"A. Kazantsev, K. Chernykh, N. Zarkua, R. Lider, E. Burkova, G. Bagdavadze, E. Y. Kalinin, T. E. Zaitseva, A. E. Chikin, Y. Linets, K. Kubachev\",\"doi\":\"10.23888/pavlovj2020283312-322\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods . 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引用次数: 4

摘要

的目标。急性脑血管事件(ACVE)不同时期颈动脉内膜切除术(CEA)的住院及远期疗效分析材料与方法。本研究为回顾性研究，采用患者抽样方法。2010 - 2019年，选取1113例有ACVE病史，后行CEA的患者。根据最后一次ACVE与CAE之间的时间间隔，将所有患者分为4组:第一组- ACVE最急性期(1-3天)(n=24;2.2%);第二组——急性期(最长28天)(n=493;44.3%);第三组-在ACVE的早期康复期(最长6个月)(n=481;43.2%);第四组-在ACVE康复后期(最长2年)(n=115;10.3%)。长期治疗34.8±12.5个月。结果。观察住院期间发生以下并发症:致死性结局(1组- 0%;第2组- 0.4% (n=2);第3组- 0.2% (n=1);第4组- 0%;р= 0.16));心肌梗死(1组- 0%;第2组- 0.4% (n=2);第3组- 0%;第4组- 0.9% (n=1);р= 0.35));ACVE/短暂性脑缺血发作(TIA)，(1组- 4.2% (n=1);第2组- 0.4% (n=2);第3组- 0.2% (n=1);第4组- 0%;1-2 =0.01;1-3 =0.009;1-4 =0.01))。住院期结束时，由致死结局+心肌梗死+ ACVE/TIA组成的复合终点，1组为- 4.2% (n=1)， 2组为- 1.2% (n=6)， 3组为- 0.4% (n=2)， 4组为- 2.6% (n=3)， r =0.08。长期随访期间的并发症有:各种原因导致的死亡结局(1组- 25% (n=6);2组- 5.5% (n=27);第3组- 7.3% (n=35);第4组- 14% (n=16);1-2 =0.002;1-3 =0.008;2-4 =0.012);心血管原因致死结果(1组- 4.2% (n=1);第2组- 3.6% (n=18);第3组- 4.8% (n=23);第4组- 5.2% (n=6);1组- 12.5% (n=3);第2组- 3.6% (n=18);第3组- 5.4% (n=26);第4组- 6.1% (n=7);1组- 16.6% (n=4);第2组- 6.3% (n=31);第3组- 6% (n=29);第4组- 11.3% (n=13);р= 0.05));复合终点包括致死结局+心肌梗死+ ACVE/TIA(1组- 54.2% (n=13);2组- 15.4% (n=76);第3组- 18.7% (n=90);第4组- 31.3% (n=36);1-2 =0.0001;1-3 =0.0001;1-4 =0.005;2-4 =0.0006;3-4 =0.012))。结论。CEA在ACVE急性期和早期康复期的应用证明了其有效性和安全性。

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Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods . The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1 st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2 nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3 rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4 th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months. Results . In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р 1-2 =0.01; р 1-3 =0.009; р 1-4 =0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р 1-2 =0.002; р 1-3 =0.008; р 2-4 =0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р 1-2 =0.0001; р 1-3 =0.0001; р 1-4 =0.005; р 2-4 =0.0006; р 3-4 =0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

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I.P.Pavlov Russian Medical Biological Herald

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