跨关节与关节支架在预防中风方面的有效性
Jesse A Columbo1,2, Pablo Martinez-Camblor3,4, David H Stone1,2
1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
JAMA network open
|April 25, 2025
概括
外科手术的横动脉复血管 (TCAR) 显示,在无症状和有症状的患者中,相比于输血性动脉支架 (TF-CAS),中风风险较低. 在三年内这种持久的好处支持TCAR作为动脉支架的潜在首选选项.
科学领域:
- 血管外科 血管外科
- 神经学 神经学
- 干预心脏病学 干预心脏病学
背景情况:
- 对于长期预防中风,跨动脉再血管化 (TCAR) 与输式动脉支架 (TF-CAS) 的比较有效性尚未得到充分证实.
- 在特定患者群体中,动脉支架对于降低中风风险至关重要.
研究的目的:
- 为了比较TCAR和TF-CAS之间的中风风险,超出了周围手术期.
- 评估TCAR与TF-CAS提供的中风预防的持久性.
主要方法:
- 使用与医疗保险索赔相关的血管植入物监测和结果网络 (VISION) 注册表进行的回顾性队列研究.
- 包括在2016年10月至2019年12月期间接受TCAR或TF-CAS的患者.
- 分析涉及Kaplan-Meier生存估计和多变量Cox比例危险模型,以评估在3年随访期间的中风和死亡风险.
主要成果:
- 在5,798名无症状患者中,与TF-CAS (9.2%) (P <.001) 相比,TCAR (5.1%) 的3年中风风险明显较低 (P <.001).
- 在4721名有症状的患者中,TCAR还显示了较低的3年中风风险 (16.6%) 与TF-CAS (20.9%) (P<.001).
- 与TF-CAS.相比,调整后的危险比率表明,在无症状 (HR,0.59;P < .001) 和有症状的患者 (HR,0.70;P < .001) 中,TCAR降低了中风风险.
结论:
- 与TF-CAS相比,TCAR与无症状和症状患者中风风险显著降低有关.
- 在降低中风风险方面,TCAR所观察到的益处在3年的随访期内是持久的.
- 这些发现提供了有价值的证据,以指导临床决策,关于动脉支架程序.
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