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Abstract：
Background: The German-Austrian guideline on the treatment of carotid stenosis recommends specialist neurological assessment (NA) before and after carotid endarterectomy (CEA) or carotid artery stenting (CAS). This study analyzes the determinants of NA and the association of NA with the perioperative rate of stroke or death. Materials and Methods: This study is a pre-planned sub-study of the ISAR-IQ project, which analyzes data from the nationwide German statutory quality assurance carotid database. Patients were classified as asymptomatic (group A), elective symptomatic (group B), and others (group C: emergency (C1), simultaneous operation (C2), and other indications (C3)). The primary outcome event (POE) of this study was any in-hospital stroke or death. Adjusted odds ratios for pre- and post-NA and the POE were calculated using multivariable regression analyses. Results: We analyzed 228,133 patients (54% asymptomatic, 68% male, mean age 72 years) undergoing CEA or CAS between 2012 and 2018. Age and sex were not associated with the likelihood of pre-NA or post-NA. The multivariable regression analysis showed an inverse association between pre-NA and POE (adjusted odds ratio (aOR) 0.47; 95% CI 0.44-0.51, p < 0.001), and a direct association of post-NA and POE (aOR 4.39; 95% CI 4.04-4.78, p < 0.001). Conclusions: Pre- and postinterventional specialist NA is strongly associated with the risk of any in-hospital stroke or death after CEA or CAS in Germany. A relevant confounding by indication or reversed causation cannot be ruled out. Nevertheless, to improve the quality assurance of treatment, the NA recommended in the guideline should be carried out consistently.
摘要：
背景：德国-奥地利关于颈动脉狭窄治疗的指南建议在颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）之前和之后进行专科神经系统评估（NA）。这项研究分析了NA的决定因素以及NA与围手术期中风或死亡率的关系。材料和方法：本研究是ISAR-IQ项目的预先计划的子研究，它分析了德国全国法定质量保证颈动脉数据库中的数据。患者被归类为无症状（A组），选择性症状（B组），和其他（C组：急诊（C1），同时操作（C2），和其他适应症（C3））。这项研究的主要结局事件（POE）是任何院内卒中或死亡。使用多变量回归分析计算NA前后和POE的调整后比值比。结果：我们分析了228,133例患者(54%无症状，68%男性，平均年龄72岁)在2012年至2018年期间接受CEA或CAS。年龄和性别与NA前或NA后的可能性无关。多元回归分析显示，NA前与POE呈负相关（调整比值比（aOR）0.47；95％CI0.44-0.51，p<0.001），NA后和POE的直接关联（aOR4.39；95%CI4.04-4.78，p<0.001）。结论：在德国，介入前和介入后的专家NA与CEA或CAS后任何院内卒中或死亡的风险密切相关。不能排除由指示或反向因果关系引起的相关混淆。然而，为了提高治疗的质量保证，指南中建议的NA应始终如一地执行。
