目的：比较外翻（ECEA）和常规颈动脉内膜切除术（CCEA）的长期效果。
方法：我们设计了一个回顾性的，多中心研究包括25,106例接受ECEA（n=18,362）或CCEA（n=6744）的患者。随访时间124.7±53.8个月。
结果：在术后期间，所有干预措施均未显示出明显的益处，可减少并发症的发生频率：致命结局（ECEA：0.19%，n=36；CCEA：0.17%，n=12；OR=1.1，95%CI=0.57-2.11，p=0.89)，心肌梗死（ECEA：0.15%，n=28；CCEA：0.13%，n=9；p=0.87；OR=1.14；95％CI=0.53-2.42）；急性脑血管意外（CVA）（I组：0.33％，n=62；第二组：0.4%，n=27；p=0.53；OR=0.84；95％CI=0，53-1.32）；干预区域出现急性血肿出血（I组：0.39％，n=73；第二组：0.41%，n=28；p=0.93；OR=0.95；95％CI=0，61-1.48）；颈内动脉（ICA）血栓形成（I组：0.05％，n=11；第二组：0.07%，n=5；OR=0.80，95%CI=0.28-2.32，p=0.90）。在长期随访中，ECEA与较低的致命结局频率相关（ECEA：2.7％，n=492；CCEA：9.1％，n=616；OR=0.27；95%CI=0.24-0.3，p<0.0001)，脑血管死亡（ECEA：1.0%，n=180；CCEA：5.5%，n=371；OR=0.17，95%CI=0.14-0.21，p<0.0001），非致死性缺血性卒中（ECEA：0.62%，n=114；CCEA：7.0%，n=472；OR=0.08；95％CI=0.06-0.1，p<0.0001）；由于>60％再狭窄而重复血运重建（ECEA：1.6％，n=296；CCEA：12.6%，n=851；OR=0.11，95%CI=0.09-0.12，p<0.0001），和合并终点(ECEA：2.2%，n=397；CCEA：13.2%，n=888；OR=0.14；95%CI=0.12-1.16，p<0.0001)。
结论：ECEA长期优于CCEA。
OBJECTIVE: To compare the long-term results of eversion (ECEA) and conventional carotid endarterectomy (CCEA).
METHODS: We designed a retrospective, multicenter
study which included 25,106 patients who underwent ECEA (n = 18,362) or CCEA (n = 6744). The duration of follow-up was 124.7 ± 53.8 months.
RESULTS: In the postoperative period, none of the interventions showed clear benefits reducing the frequency of complications: fatal outcome (ECEA: 0.19%, n = 36; CCEA: 0.17%, n = 12; OR = 1.1, 95% CI = 0.57-2.11, p = 0.89), myocardial infarction (ECEA: 0.15%, n = 28; CCEA: 0.13%, n = 9; p = 0.87; OR = 1.14; 95% CI = 0.53-2.42); acute cerebrovascular accident (CVA) (Group I: 0.33%, n = 62; Group II: 0.4%, n = 27; p = 0.53; OR = 0.84; 95% CI = 0, 53-1.32); bleeding with acute haematoma appearance in the area of intervention (Group I: 0.39%, n = 73; Group II: 0.41%, n = 28; p = 0.93; OR = 0.95; 95% CI = 0, 61-1.48); internal carotid artery (ICA) thrombosis (Group I: 0.05%, n = 11; Group II: 0.07%, n = 5; OR = 0.80, 95% CI = 0.28-2.32, p = 0.90). During the long-term follow-up, ECEA was associated with lower frequency of fatal outcome (ECEA: 2.7%, n = 492; CCEA: 9.1%, n = 616; OR = 0.27; 95% CI = 0.24-0.3, p < 0.0001), cerebrovascular death (ECEA: 1.0%, n = 180; CCEA: 5.5%, n = 371; OR = 0.17, 95% CI = 0.14-0.21, p < 0.0001), non-fatal ischaemic stroke (ECEA: 0.62%, n = 114; CCEA: 7.0%, n = 472; OR = 0.08; 95% CI = 0.06-0.1, p < 0.0001); repeated revascularization because of >60% restenosis (ECEA: 1.6%, n = 296; CCEA: 12.6%, n = 851; OR = 0.11, 95% CI = 0.09-0.12, p < 0.0001), and combined endpoint (ECEA: 2.2%, n = 397; CCEA: 13.2%, n = 888; OR = 0.14; 95% CI = 0.12-1.16, p < 0.0001).
CONCLUSIONS: ECEA is beneficial over CCEA in a long term.
