■本研究的目的是评估性别对接受颈动脉支架置入术(CAS)的无症状患者的影响。
■一项回顾性观察研究于2006年1月至2020年12月进行。共有438例无症状颈动脉狭窄>70%的连续患者接受了经股动脉CAS,并分为男性(M)和女性(F)。围手术期30天结果为:卒中,死亡,心肌梗死(MI)。随访结果为:死亡率和卒中发生率(主要),再狭窄发生率(FFR)和再干预率(次要)。随访数据分别在1年、5年和10年进行分析。数据采用χ2检验和Fisher精确检验分析,随访结果采用Kaplan-Meier曲线分析。使用对数秩检验来确定组间的差异,并进行单因素分析以确定危险因素和术中细节与死亡率和再狭窄率之间的关联。
■总共进行了462个手术(M:n=321,69.4%),其中24个CAS为双侧(5.5%)。平均年龄为71.9±7.6岁(M:72.1±7.8;F:71.7±7.3)。围手术期结果为:卒中发生率2.2%(n=10;M:n=5,1.6%;F:n=5,3.5%;p=0.176),死亡率0.6%(M:n=3,p=0.334),卒中/死亡率为2.8%(n=13;M:n=8,2.5%;F:n=5,3.5%;p=0.528);没有记录到心脏事件(MI)。3名男性(0.9%)发现非致残(轻微)中风,据报道,有7例患者(1.7%)发生了致残(严重)中风,其中5例为缺血性事件(M:n=2,0.6%;F:n=3,2.2%),2例为脑出血(F:1.3%,p=0.046)。平均随访时间为73.66±40.83个月(M:72.66;F:76.01;p=0.246)。总生存率为96.1%(95%置信区间[CI]:93-98),81.8%(95%CI:77-86),在1年、5年和10年时为45.5%(95%CI:38-53),分别(p=0.236)。总卒中发生率为0.3%(卒中自由[FFS]:99.7%;95%CI:98-100),0.9%(FFS:99%;95%CI:98-100),和4.3%(FFS:95.7%;95%CI:89-98;M:n=6;F:n=2;p=0.774)。5年和10年卒中相关死亡率分别为0.7%(FFS:99.3%;95%CI:97-100)和2.9%(FFS:97.1%;95%CI:91-99),分别,组间无差异(M:n=4;F:n=2;p=0.763)。总体FFR率为97.4%(95%CI:95-99),93.4%(95%CI:90-96),和89.5%(95%CI:84-93;p=0.322)。两次严重症状性再狭窄(>70%,M)需要新的血管内血运重建。
■在短期和长期随访中,性别变量不影响无症状患者的CAS结果,尽管女性表现出最严重的围手术期主要中风的发生率。当仔细选择患者时,可以安全地建议颈动脉支架置入术。
结论:性别变量被认为是影响经股颈动脉支架置入术(CAS)结果的重要因素。文献数据形成对比,即使不同的论文主要报道CAS与女性患者的最差结局相关.我们的研究表明,在短期和长期随访中,性别变量不会影响无症状患者的CAS结果,尽管女性的围手术期主要卒中发生率最差。当应用仔细的患者选择时,可以安全地提出CAS。
UNASSIGNED: Aim of the study was to evaluate the influence of sex in asymptomatic patients undergoing carotid artery stenting (CAS).
UNASSIGNED: A retrospective observational study was conducted from January 2006 to December 2020. A total of 438 consecutive patients with asymptomatic carotid artery stenosis >70% underwent transfemoral CAS and were stratified in males (M) and females (F). Periprocedural 30-day outcomes were: stroke, death, and myocardial infarction (MI). Follow-up outcomes were: death and stroke rates (primary) and freedom from restenosis (FFR) and reintervention rates (secondary). Follow-up data were analyzed at 1, 5, and 10 years. Data were analyzed with χ2 test and Fisher\'s exact test and follow-up outcomes with Kaplan-Meier curves. The log-rank test was used to determine differences between the groups and univariate analysis to identify the association between risk factors and intraoperative details with mortality and restenosis rates.
UNASSIGNED: A total of 462 procedures were performed (M: n=321, 69.4%), in which 24 CAS were bilateral (5.5%). Mean age was 71.9±7.6 years (M: 72.1±7.8; F: 71.7±7.3). Periprocedural outcomes were: stroke rate 2.2% (n=10; M: n=5, 1.6%; F: n=5, 3.5%; p=0.176), mortality rate 0.6% (M: n=3, p=0.334), and stroke/death rate 2.8% (n=13; M: n=8, 2.5%; F: n=5, 3.5%; p=0.528); no cardiac events (MI) were recorded. A not-disabling (minor) stroke was detected in 3 males (0.9%), while a disabling (major) stroke was reported in 7 patients (1.7%) of whom 5 were ischemic events (M: n=2, 0.6%; F: n=3, 2.2%) and 2 were cerebral hemorrhages (F: 1.3%, p=0.046). Mean follow-up was 73.66±40.83 months (M: 72.66; F: 76.01; p=0.246). Overall survival rate was 96.1% (95% confidence interval [CI]: 93-98), 81.8% (95% CI: 77-86), and 45.5% (95% CI: 38-53) at 1, 5, and 10 years, respectively (p=0.236). The overall stroke rate was 0.3% (freedom from stroke [FFS]: 99.7%; 95% CI: 98-100), 0.9% (FFS: 99%; 95% CI: 98-100), and 4.3% (FFS: 95.7%; 95% CI: 89-98; M: n=6; F: n=2; p=0.774). Stroke-related mortality rate was 0.7% (FFS: 99.3%; 95% CI: 97-100) and 2.9% (FFS: 97.1%; 95% CI: 91-99) at 5 and 10 years, respectively, without differences between the groups (M: n=4; F: n=2; p=0.763). Overall FFR rate was 97.4% (95% CI: 95-99), 93.4% (95% CI: 90-96), and 89.5% (95% CI: 84-93; p=0.322). Two severe symptomatic restenosis (>70%, M) required a new endovascular revascularization.
UNASSIGNED: The sex variable does not influence outcomes of CAS in asymptomatic patients at short- and long-term follow-up, although females show a worst incidence of periprocedural major strokes. Carotid artery stenting may be safely proposed when a careful patient selection is applied.
CONCLUSIONS: The sex variable has been advocated as a considerable factor that could influence the outcomes of transfemoral carotid artery stenting (CAS). Literature data are contrasting, even if different papers mainly reported that CAS is associated to worst outcomes in female patients. Our study shows that the sex-variable does not influence outcomes of CAS in asymptomatic patients at short and long-term follow-up, although females had a worst incidence of periprocedural major strokes. CAS may be safely proposed when a careful patient selection is applied.