BACKGROUND Carotid endarterectomy and carotid artery stenting are common procedures for the treatment of carotid artery stenosis. The aim of this study was to identify factors that modify the effect between type of treatment and outcome, and could thus be used to refine the selection of treatment procedure. METHODS All patients who underwent either carotid endarterectomy or carotid artery stenting between 2012 and 2018 in German hospitals were included. The analysis of effect modification was focused on baseline patient characteristics. The outcome was a composite of any stroke or death until discharge from hospital. For multivariable analyses, a generalized linear mixed regression model was used. RESULTS Some 221 282 patients were included, of whom 68% were male. In patients who underwent carotid endarterectomy or carotid artery stenting, the risk of any stroke or death was 2.3% and 3.7% respectively. Patient age was statistically significantly associated with a higher risk of a composite outcome of any stroke or death (main effect of age: adjusted OR 1.21 (95% c.i. 1.17 to 1.26), P < 0.001). The age effect was stronger in patients treated with carotid artery stenting (interaction effect: adjusted OR 1.29 (95% c.i. 1.20 to 1.38), P < 0.001). Statistically significant interaction effects were identified for side of treatment, ASA grade, contralateral degree of stenosis, and the time interval between the index event and treatment. CONCLUSION This analysis shows that carotid artery stenting may be particularly disadvantageous in older patients, in patients with right-sided stenosis, and in symptomatic patients treated within the first 2 days after the index event. In patients with contralateral occlusion, carotid artery stenting appears equivalent to carotid endarterectomy.

中文翻译：

---

确定可能改进治疗颈动脉狭窄的手术选择的患者特征。


背景 颈动脉内膜切除术和颈动脉支架置入术是治疗颈动脉狭窄的常见手术。本研究的目的是确定改变治疗类型和结果之间效果的因素，从而可用于改进治疗程序的选择。方法 纳入 2012 和 2018 年在德国医院接受颈动脉内膜切除术或颈动脉支架置入术的所有患者。效果改变的分析集中在基线患者特征上。结局是出院前任何中风或死亡的复合结果。对于多变量分析，使用了广义线性混合回归模型。结果 纳入约 221 282 例患者，其中 68% 为男性。在接受颈动脉内膜切除术或颈动脉支架置入术的患者中，任何中风或死亡的风险分别为 2.3% 和 3.7%。患者年龄与任何卒中或死亡的复合结局风险较高具有统计学意义相关（年龄的主要效应：校正 OR 1.21 （95% CI 1.17 至 1.26），P < 0.001）。颈动脉支架置入术治疗的患者的年龄效应更强 （交互效应：校正 OR 1.29 （95% CI 1.20 至 1.38），P < 0.001）。确定了治疗侧、 ASA 分级、对侧狭窄程度以及指标事件与治疗之间的时间间隔的统计学显着交互效应。结论 该分析表明，颈动脉支架置入术对老年患者、右侧狭窄患者以及指数事件后前 2 天内接受治疗的有症状患者可能特别不利。 在对侧闭塞患者中，颈动脉支架置入术似乎等同于颈动脉内膜切除术。