Abstract：
BACKGROUND: The main objective of this study is to evaluate and compare the outcomes regarding operative mortality rate, ipsilateral stroke, and overall survival rate among patients with internal carotid artery stenosis submitted to carotid endarterectomy (CEA) or stenting regarding the completeness of circle of Willis (CoW).
METHODS: Prospective, consecutive cohort study of patients submitted to carotid interventions (CEA and carotid stenting: CAS) for internal carotid artery stenosis diagnosis evaluated according complete or incomplete CoW. The patients were divided into 2 groups: group I, the patients with complete CoW and group II, the patients with incomplete CoW, with the disruption of anterior and/or ipsilateral posterior circulation, regarding the ipsilateral significant carotid stenosis.
RESULTS: Overall, 98 patients submitted to carotid intervention were evaluated. Two groups of patients were identified: group CoW complete with 54 patients and group CoW incomplete with 44 patients. Regarding the type of intervention, the prevalence of CAS in CoW complete group and CoW incomplete group were statistically similar (54.1% vs. 55.1%, P = 0.22). Notwithstanding, CEA was also statistically similar in CoW incomplete group and CoW complete group (44.2% vs. 45.9%, P = 0.22). The perioperative mortality rate was 2% in total cohort (2 patients), with no differences among CoW complete and incomplete groups (3.7% vs. 0%, P = 0.50, respectively). Furthermore, the incidence of postoperative stroke was 3.1% (asymptomatic 2%, symptomatic 1.1%), with no differences among CoW complete and incomplete groups (3.7% vs. 2.3%, P = 0.68, respectively). A univariate and multivariate linear regression showed that among the factors evaluated, only chronic kidney failure was related with hazard ratio = 1.89, P = 0.003, confidence interval 1.058-2.850.
CONCLUSIONS: The completeness of the CoW, independently of the type of carotid intervention (CEA and CAS), did not interfere in the results regarding postoperative outcomes for stroke and death. Chronic kidney disease was associated to increased risk of perioperative stroke.
METHODS: Prospective, consecutive cohort study of patients submitted to carotid interventions (CEA and carotid stenting: CAS) for internal carotid artery stenosis diagnosis evaluated according complete or incomplete CoW. The patients were divided into 2 groups: group I, the patients with complete CoW and group II, the patients with incomplete CoW, with the disruption of anterior and/or ipsilateral posterior circulation, regarding the ipsilateral significant carotid stenosis.
RESULTS: Overall, 98 patients submitted to carotid intervention were evaluated. Two groups of patients were identified: group CoW complete with 54 patients and group CoW incomplete with 44 patients. Regarding the type of intervention, the prevalence of CAS in CoW complete group and CoW incomplete group were statistically similar (54.1% vs. 55.1%, P = 0.22). Notwithstanding, CEA was also statistically similar in CoW incomplete group and CoW complete group (44.2% vs. 45.9%, P = 0.22). The perioperative mortality rate was 2% in total cohort (2 patients), with no differences among CoW complete and incomplete groups (3.7% vs. 0%, P = 0.50, respectively). Furthermore, the incidence of postoperative stroke was 3.1% (asymptomatic 2%, symptomatic 1.1%), with no differences among CoW complete and incomplete groups (3.7% vs. 2.3%, P = 0.68, respectively). A univariate and multivariate linear regression showed that among the factors evaluated, only chronic kidney failure was related with hazard ratio = 1.89, P = 0.003, confidence interval 1.058-2.850.
CONCLUSIONS: The completeness of the CoW, independently of the type of carotid intervention (CEA and CAS), did not interfere in the results regarding postoperative outcomes for stroke and death. Chronic kidney disease was associated to increased risk of perioperative stroke.
摘要：
目的：本研究的主要目的是评估和比较手术死亡率的结果，接受颈动脉内膜切除术或支架置入术的颈内动脉（ICA）狭窄患者的同侧卒中和总生存率，关于威利斯环（CoW）的完整性。
方法：前瞻性，根据完全或不完全CoW评估接受颈动脉介入治疗（颈动脉内膜切除术-CEA-和颈动脉支架置入术-CAS）的患者的连续队列研究，以诊断ICA狭窄。将患者分为两组：I组-完全CoW患者和II组-不完全CoW患者，与前和/或同侧后循环的破坏，关于同侧显著颈动脉狭窄。
结果：总体而言，对98例接受颈动脉介入治疗的患者进行了评估。确定了两组患者：CoW完成组54例患者，CoW不完全组44例患者。关于干预的类型，CoW完全组和CoW不完全组的CAS患病率在统计学上相似(54.1%对55.1%,p=0.22）。尽管如此,CoW不完全组和CoW完全组的CEA也在统计学上相似(44.2%对45.9%,p=0.22）。围手术期死亡率为2％的总队列（2例），CoW完全组和不完全组之间没有差异(3.7%对0%，分别为p=0.50)。此外，术后卒中的发生率为3.1％（无症状的2％，症状1.1%)，CoW完全组和不完全组之间没有差异(3.7%对2.3%，分别为p=0.68)。单变量和多变量线性回归表明，在评估的因素中，只有慢性肾衰竭与HR=1.89，p=0.003，CI1.058-2.850相关。
结论：CoW的完整性，与颈动脉介入类型(CEA和CAS)无关，未干扰卒中和死亡的术后结局.慢性肾脏病与围手术期卒中风险增加相关。
方法：前瞻性，根据完全或不完全CoW评估接受颈动脉介入治疗（颈动脉内膜切除术-CEA-和颈动脉支架置入术-CAS）的患者的连续队列研究，以诊断ICA狭窄。将患者分为两组：I组-完全CoW患者和II组-不完全CoW患者，与前和/或同侧后循环的破坏，关于同侧显著颈动脉狭窄。
结果：总体而言，对98例接受颈动脉介入治疗的患者进行了评估。确定了两组患者：CoW完成组54例患者，CoW不完全组44例患者。关于干预的类型，CoW完全组和CoW不完全组的CAS患病率在统计学上相似(54.1%对55.1%,p=0.22）。尽管如此,CoW不完全组和CoW完全组的CEA也在统计学上相似(44.2%对45.9%,p=0.22）。围手术期死亡率为2％的总队列（2例），CoW完全组和不完全组之间没有差异(3.7%对0%，分别为p=0.50)。此外，术后卒中的发生率为3.1％（无症状的2％，症状1.1%)，CoW完全组和不完全组之间没有差异(3.7%对2.3%，分别为p=0.68)。单变量和多变量线性回归表明，在评估的因素中，只有慢性肾衰竭与HR=1.89，p=0.003，CI1.058-2.850相关。
结论：CoW的完整性，与颈动脉介入类型(CEA和CAS)无关，未干扰卒中和死亡的术后结局.慢性肾脏病与围手术期卒中风险增加相关。
