Long-term effects of interventional therapy vs drug on severe carotid artery stenosis / 中华神经科杂志

ABSTRACT

Objective To identify the prognosis factors of the patients with high-degree carotid artery stenosis and evaluate the effect of different therapy prospectively.Methods A hundred and three patients with spoke or tansient ischemic attack(TIA)suffering from severe carotid artery stenosis were included into this study consectively.They were given intra-artery intervention or antiplatelet therapy based on clinical factors and the intension of the patients or their Legally Autllorized Representative (LAR)and thus divided into 2 groups.Forty patients were transplanted with stent,63 were given only with antiplatelet drugs.The major outcome of end-point was the 2-year functional prognosis evaluated by modified Rankin score(mRS),while the minor one was the cardiovascular events in 1 year.2 year or longer after the index stroke or TIA,which was defined as stroke,TIA,acute myocardic infarction(AMI)and sudden death in this study.Results There were no statistical significances of sex,years,medical histories,blood pressure, total cholesterol,triglyceide in two groups at baseline.For the major outcome,intra-artery intervention was an independent protective factor for impaired function(mRS 3-6)with the method of binary Logistic(RR= 0.13,P=0.001,95%CI 0.036-0.460).For the minor outcome,the incidence of the cardiovascular events in 1 year and 2 year after the index stroke or TIA was lower in the intra-artery intervention group than in the antiplatelet therapy(For 1 year follow up,intervention groupantiplatelet therapy group= 12.5%42.9%,OR=0.19,95%CI 0.07-0.55,P=0.001;For 2 year follow up,17.5%47.6%,OR =0.23,95%CI 0.09-0.60,P=0.002).The median time of cardiovascular events in the two groups was further investigated in 55 months and 54 months separately. Kaplan-Meier analysis showed no significant difference.Survival analysis with Cox-regression showed that neither therapy of intra-artery intervention nor antiplatelet therapy was an independent factor for the cardiovascular events(RR=1.063,95%CI 0.40- 2.83,P=0.900).Conclusions For the stroke or TIA patients suffering from high-degree carotid artery stenosis,intra-artery intervention is superior pure drug therapy in achieving better theapeutical effect and reducing the incidence of the cardiovascular events after the index stroke or TIA.However,its long term effect needs further study.