肥胖对接受颈动脉支架置入手术患者血管解剖形态和术后结局的影响

Effects of obesity on vascular anatomy and post-operative outcomes in patients undergoing carotid artery stenting

目的探讨肥胖对接受颈动脉支架置入术(carotid artery stenting,CAS)患者血管解剖形态和术后结局的影响,旨在为肥胖患者治疗方式的选择提供依据。方法收集2020年1月1日至2022年12月31日在山西医科大学第一医院卒中中心择期接受CAS治疗的患者的病历资料及数字化减影血管造影影像资料,据入院时的体重指数将患者分为肥胖组及非肥胖组,比较两组患者血管解剖特征及围术期不良事件发生率,利用三步回归法进一步探讨血管解剖在肥胖与CAS围术期不良事件的相关性作用。结果共纳入298例患者,其中肥胖组患者血管解剖的布法罗风险评分更高,高风险血管解剖更常见(P<0.05)。肥胖组患者CAS围术期卒中事件的发生率高于非肥胖组(18.5%比5.2%,P=0.007)。中介效应检验提示,高风险血管解剖是肥胖影响CAS围术期卒中发生率的完全中介变量。结论肥胖通过形成复杂的血管解剖特征进而导致术后不良事件发生风险增加。

Objective To investigate the effect of obesity on vascular anatomy and post-operative outcomes in patients undergoing carotid artery stenting(CAS),and to inform the choice of treatment options for obese patients.Methods Patients who underwent CAS in the Stroke Center of First Hospital of Shanxi Medical University between January 1st,2020 and December 31st,2022 were collected,and their medical records and digital subtraction angiography images were collected.All patients were divided into obese group and non-obese group based on the body mass index at admission.Vascular anatomy and the incidence of peri-operative adverse outcomes were compared between the two groups.The three-step regression method was used to further explore the role of vascular anatomy in the correlation between obesity and peri-operative adverse outcomes in CAS.Results A total of 298 patients were included.The Buffalo Risk Assessment Scale index was higher for the obese group,and high-risk vascular anatomy was more common in the obese group(P<0.05).The incidence of peri-operative stroke in the obese group was higher than that in the non-obese group(18.5%vs.5.2%,P=0.007).The mediation analysis suggested the full mediation effect of high-risk vascular anatomy on obesity to influence the incidence of peri-operative stroke after CAS.Conclusion Obesity increases the risk of post-operative adverse outcomes via inducing the development of complex vascular anatomy.