Stroke:颈动脉支架植入术与动脉内膜切除术治疗无症状颈动脉狭窄的疗效比较

2022-06-27 MedSci原创 MedSci原创

在治疗无症状颈动脉狭窄时,CAS与CEA相比,具有相似的围手术期和长期综合结果。

为了比较颈动脉支架术(CAS)和颈动脉内膜切除术(CEA)治疗无症状颈动脉狭窄的安全性和有效性,来自宣武医院神经外科的学者开展了一项荟萃分析,结果发表在stroke杂志上。

该研究学者在EMBASE、PubMed、MEDLINE和Cochrane图书馆的数据库中搜索了比较CAS和CEA治疗无症状颈动脉狭窄的随机对照试验。由两位独立评审员确定了符合条件的研究,提取了相关数据,并使用Cochrane偏倚风险工具来评估质量。使用Mantel-Haenszel方法的随机效应模型来估计CAS和CEA之间围手术期风险的几率(OR)。通过Exp[(O-E)/Var]固定效应模型提取Kaplan-Meier曲线数据并进行分析,以计算有关长期结果的Peto赔率(OR)。

共纳入7项随机对照试验的16篇文章,报告了7230名无症状颈动脉狭窄患者的相关结果(CAS:n=3920;CEA:n=3198)。与CEA组相比,CAS组在围手术期复合终点事件中没有差异,包括卒中、死亡和心肌梗死

与CEA相比,CAS在围手术期发生任何中风的风险较高(OR=1.62[95% CI,1.16-2.24]),非致残性中风的风险增加(OR=1.81 [95% CI, 1.23-2.65]),但组间致残性中风和死亡没有明显差异(OR,=0.91 [95% CI, 0.50-1.65])。就长期结果而言,关于任何中风、死亡和心肌梗死的综合结果,CEA和CAS之间不存在差异(Peto OR=1.18[95% CI,0.94-1.48])。

在治疗无症状颈动脉狭窄时,CAS与CEA相比,具有相似的围手术期和长期综合结果。然而,CAS在围手术期可能有更高的任何中风和非致残性中风的风险。

 

参考文献:

Carotid Stenting Versus Endarterectomy for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

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[GetPortalCommentsPageByObjectIdResponse(id=1843663, encodeId=f888184366352, 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=56, 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=Thu Oct 20 11:55:39 CST 2022, time=2022-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1984484, encodeId=b5c0198448419, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100542, encryptionId=5f7310054216, topicName=颈动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=, 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  5. [GetPortalCommentsPageByObjectIdResponse(id=1843663, encodeId=f888184366352, 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=56, 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=Thu Oct 20 11:55:39 CST 2022, time=2022-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1984484, encodeId=b5c0198448419, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100542, encryptionId=5f7310054216, topicName=颈动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=, 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  6. [GetPortalCommentsPageByObjectIdResponse(id=1843663, encodeId=f888184366352, 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=56, 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=Thu Oct 20 11:55:39 CST 2022, time=2022-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1984484, encodeId=b5c0198448419, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100542, encryptionId=5f7310054216, topicName=颈动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=, 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  7. 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objectType=article, channel=null, level=null, likeNumber=37, 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=Fri Jan 13 21:55:39 CST 2023, time=2023-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485291, encodeId=b02a1485291c5, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496953, encodeId=9588149695304, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520808, encodeId=11bb15208089c, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1591188, encodeId=11151591188ef, content=<a href='/topic/show?id=2e1e5e109a9' target=_blank style='color:#2F92EE;'>#支架植入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57109, encryptionId=2e1e5e109a9, topicName=支架植入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e8c817920738, createdName=amy0556, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1843663, encodeId=f888184366352, 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=56, 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=Thu Oct 20 11:55:39 CST 2022, time=2022-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1984484, encodeId=b5c0198448419, 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=46, 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=Thu May 04 07:55:39 CST 2023, time=2023-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708713, encodeId=f7281e08713ba, content=<a href='/topic/show?id=4c2d3051535' target=_blank style='color:#2F92EE;'>#内膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, 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=Sun Jan 22 00:55:39 CST 2023, time=2023-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967450, encodeId=6301196e450bf, content=<a href='/topic/show?id=ba21590e1f9' target=_blank style='color:#2F92EE;'>#无症状颈动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59071, encryptionId=ba21590e1f9, topicName=无症状颈动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c279140, createdName=vividelife, createdTime=Thu Apr 20 11:55:39 CST 2023, time=2023-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935179, encodeId=9a7f19351e9bd, content=<a href='/topic/show?id=49455e1086e' target=_blank style='color:#2F92EE;'>#支架植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57108, encryptionId=49455e1086e, topicName=支架植入)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Sat Nov 12 23:55:39 CST 2022, time=2022-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877590, encodeId=e26e18e7590e1, 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=37, 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=Fri Jan 13 21:55:39 CST 2023, time=2023-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485291, encodeId=b02a1485291c5, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496953, encodeId=9588149695304, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520808, encodeId=11bb15208089c, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1591188, encodeId=11151591188ef, content=<a href='/topic/show?id=2e1e5e109a9' target=_blank style='color:#2F92EE;'>#支架植入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57109, encryptionId=2e1e5e109a9, topicName=支架植入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e8c817920738, createdName=amy0556, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1843663, encodeId=f888184366352, 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=56, 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=Thu Oct 20 11:55:39 CST 2022, time=2022-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1984484, encodeId=b5c0198448419, 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=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100542, encryptionId=5f7310054216, topicName=颈动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=, 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objectType=article, channel=null, level=null, likeNumber=37, 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=Fri Jan 13 21:55:39 CST 2023, time=2023-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485291, encodeId=b02a1485291c5, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1496953, encodeId=9588149695304, content=<a href='/topic/show?id=217b33259df' target=_blank style='color:#2F92EE;'>#动脉狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33259, encryptionId=217b33259df, topicName=动脉狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4ae9287436, createdName=piaojinhua, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520808, encodeId=11bb15208089c, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1591188, encodeId=11151591188ef, content=<a href='/topic/show?id=2e1e5e109a9' target=_blank style='color:#2F92EE;'>#支架植入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57109, encryptionId=2e1e5e109a9, topicName=支架植入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e8c817920738, createdName=amy0556, createdTime=Fri Jun 24 13:55:39 CST 2022, time=2022-06-24, status=1, ipAttribution=)]
    2022-06-24 jiyangfei
  10. 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