Analysis of perioperative cerebrovascular events after carotid endarteretomy

doi:10.11817/j.issn.1673-9248.2020.04.008

Abstract

Abstract:

Objective

Case data of carotid endarterectomy(CEA) were analyzed to obtain the characteristics of perioperative cerebrovascular events and associated risk factor.

Methods

We retrospected 209 cases of CEA in Beijing Tiantan Hospital from January 2012 to April 2015, and analyzed the clinical characteristics. Relevant factors of perioperative cerebrovascular events were tested by χ² and the odds ratio (OR) was calculated.

Results

There were more males than females (177∶32). Cerebal infarction was the most common clinical manifestation (68.42%). Hypertension was the most common comorbidity (68.42%). There were 9 cases with hyperperfusion, 3 cases with cerebral hemorrhage in 5 cases with stroke during perioperative period. The proportion of hyperlipidemia in patients with hyperperfusion (8/9), chronic obstructive pulmonary disease (COPD) and chronic renal insufficiency (CRI) in patients with cerebral hemorrhage (2/3) were high. Univariate analysis by χ² test showed that hyperlipidemia was a risk factor for perioperative cerebrovascular events (OR=3.861, P=0.029). Besides concomitant hyperlipidemia was a risk factor for perioperative hyperperfusion (OR=17.397, P=0.001).The presence of chronic obstructive pulmonary disease in patients was a risk factor for perioperative stroke (OR=33.333, P=0.007), and also a risk factor for perioperative intracerebral hemorrhage(OR=101.000, P=0.002)., Chronic renal insufficiency was a risk factor for perioperative intracerebral hemorrhage (OR=51.000, P=0.043).

Conclusion

Hyperperfusion was the most common cerebrovascular events during perioperative period of CEA, and cerebral hemorrhage was the most serious cerebrovascular events. Hyperlipidemia increased the risk of hyperperfusion.Patients with COPD and CRI had a higher risk of perioperative cerebral hemorrhage.

Key words: Carotid endarterectomy, Perioperative period, Cerebrovascular events

Te Xiao, Dong Zhang, Lebao Yu, Shanshan Liu. Analysis of perioperative cerebrovascular events after carotid endarteretomy[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2020, 14(04): 226-229.

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https://zhnxgbzz.cma-cmc.com.cn/EN/Y2020/V14/I04/226

Figures/Tables 2

References 11

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特征		例数（%）	卒中（例）	脑血管事件
特征		例数（%）	卒中（例）	例数	χ²值	OR值	95%CI	P值
女		32（15.31）	0	2	0.000	1.091	0.232~5.123	1.000
男		177（84.69）	5	12
年龄＞70岁		60（28.71）	3	5	0.086	1.414	0.454~4.408	0.769
吸烟		80（38.28）	1	5	0.058	0.870	0.281~2.694	0.809
术侧狭窄＞90%^a		118（56.46）	1	8	0.116	1.222	0.386~3.870	0.733
对侧狭窄		98（46.89）	2	7	0.050	1.143	0.386~3.381	0.823
合并颅内血管狭窄		59（28.23）	3	6	0.905	2.009	0.666~6.064	0.341
神经系统症状^b
	无症状	9（4.31）	0	1	-	1.798	0.209~15.492	0.471
	TIA	104（49.76）	3	7	0.286	0.742	0.248~2.219	0.593
	脑梗死	143（68.42）	4	11	0.301	1.750	0.472~6.495	0.584
合并症
	高血压	143（68.42）	5	12	2.077	2.931	0.637~13.490	0.253
	高脂血症	71（33.97）	1	9	4.784	3.861	1.242~12.001	0.029
	2型糖尿病	70（33.49）	4	7	1.127	2.095	0.705~6.230	0.288
	心脏病	41（19.62）	1	4	0.276	1.708	0.508~5.748	0.600
	COPD	6（2.87）	2	2	-	7.958	1.322~47.896	0.054
	CRI	3（1.44）	1	1	-	7.423	0.631~87.345	0.189
	ASO	7（3.35）	0	1	-	2.423	0.271~21.658	0.389

特征		例数（%）	卒中（例）	脑血管事件
特征		例数（%）	卒中（例）	例数	χ²值	OR值	95%CI	P值
女		32（15.31）	0	2	0.000	1.091	0.232~5.123	1.000
男		177（84.69）	5	12
年龄＞70岁		60（28.71）	3	5	0.086	1.414	0.454~4.408	0.769
吸烟		80（38.28）	1	5	0.058	0.870	0.281~2.694	0.809
术侧狭窄＞90%^a		118（56.46）	1	8	0.116	1.222	0.386~3.870	0.733
对侧狭窄		98（46.89）	2	7	0.050	1.143	0.386~3.381	0.823
合并颅内血管狭窄		59（28.23）	3	6	0.905	2.009	0.666~6.064	0.341
神经系统症状^b
	无症状	9（4.31）	0	1	-	1.798	0.209~15.492	0.471
	TIA	104（49.76）	3	7	0.286	0.742	0.248~2.219	0.593
	脑梗死	143（68.42）	4	11	0.301	1.750	0.472~6.495	0.584
合并症
	高血压	143（68.42）	5	12	2.077	2.931	0.637~13.490	0.253
	高脂血症	71（33.97）	1	9	4.784	3.861	1.242~12.001	0.029
	2型糖尿病	70（33.49）	4	7	1.127	2.095	0.705~6.230	0.288
	心脏病	41（19.62）	1	4	0.276	1.708	0.508~5.748	0.600
	COPD	6（2.87）	2	2	-	7.958	1.322~47.896	0.054
	CRI	3（1.44）	1	1	-	7.423	0.631~87.345	0.189
	ASO	7（3.35）	0	1	-	2.423	0.271~21.658	0.389

并发症	例数	合并症		比率	χ²值	OR值	95%CI	P值
卒中	5	COPD	有	2/6	-	33.333	4.314~257.561	0.007
			无	3/203
		CRI	有	1/3	-	25.250	1.882~338.756	0.070
			无	4/206
		糖尿病	有	4/70	3.065	8.364	0.917~76.305	0.080
			无	1/139
脑出血	3	COPD	有	2/6	-	101.000	7.528~1355.023	0.002
			无	1/203
		CRI	有	1/3	-	51.000	3.179~818.136	0.043
			无	2/206
高灌注	9	高脂血症	有	8/71	10.216	17.397	2.130~142.088	0.001
			无	1/138

并发症	例数	合并症		比率	χ²值	OR值	95%CI	P值
卒中	5	COPD	有	2/6	-	33.333	4.314~257.561	0.007
			无	3/203
		CRI	有	1/3	-	25.250	1.882~338.756	0.070
			无	4/206
		糖尿病	有	4/70	3.065	8.364	0.917~76.305	0.080
			无	1/139
脑出血	3	COPD	有	2/6	-	101.000	7.528~1355.023	0.002
			无	1/203
		CRI	有	1/3	-	51.000	3.179~818.136	0.043
			无	2/206
高灌注	9	高脂血症	有	8/71	10.216	17.397	2.130~142.088	0.001
			无	1/138

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