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1、CEAandStrokePreventioninChinaDouglasJ.Wirthlin,M.D.DivisionofVascularSurgeryDepartmentofCardiovascularMedicineIntermountainHealthCare,SaltLakeCity,UtahChinapopulation~1.27billionUSpopulation~0.29billionStroke–#1causeofdeath1.5millionnewstrokes/yr1millionstrokedeat
2、hs/yrStroke–#3causeofdeath0.5millionnewstrokes/yr0.2millionstrokedeaths/yr1996-2000,8258strokes,10populations>75%CTscansHemorrhagic29.3%Ischemic62.4%Embolic?Intracranial?Unknown?Heart?Carotid?Stroke2003;34:2091-6CausesofStrokeinChina~20%CarotidEndarterectomy(CEA)i
3、nUSA<2%mortality0-5%strokerate1-2dayLOS~10xreductioninstrokeriskNorthAmericanSymptomaticCarotidEndarterectomyTrial(NASCET)NEJM325:445;1991AsymptomaticCarotidAtherosclerosisStudy(ACAS)*JAMA273:1421,1995CEAonlyeffectiveif:1.outcomesaregood2.expectedpatientsurvival2-
4、5yearsCarotidEndarterectomyinMainlandChinaDouglasJWirthlinMD,QinYiZhangMD,GenXueQuMD,JianLinLiuMD,XengMengMD,RaphaelCSunBS,NaiDongWangMD,DonaldBDotyMD.XianJianTongUniversityNo.1Xian,People’sRepublicofChinaIntermountainHealthCare,LDSHospital,SaltLakeCity,UtahFebrua
5、ry2002–presentFebruary2002–July20042exchangesinUSA2exchangesinChinaResults(4/02-7/04)104CEAperformedin4hospitalsUSsurgeon(3cases)Demographics65CEAin60patients48male,12femaleHypertension47(78%)Hypercholesterolemia57(95%)Smoking31(52%)Diabetes14(23%)NeurologicPresen
6、tationAsymptomatic0(0%)TIA4(7%)Stroke61(93%)Minor36(67%)Major22(33%)62y/omanSmoking,HTNRMOBLSidedweaknessBilateralICAocclusionsOperativeTechniqueGeneralAnesthesia64(98%)Shunt64(98%)LongitudinalEndart.65(100%)Primaryclosure59(91%)Prostheticpatch6(9%)30dayOutcomesMo
7、rtality0(0%)MI0(0%)Neurologicevents4(6%)Major3(5%)Minor(TIA)1(2%)CNinjury6(10%)Bleeding1(2%)LOS/HospitalChargesMeanLOS26+20days(10-127d)MeanOperativeCharges13,389+4937RMB~(1,613+595US$)MeanTotalCharges24,151+2557RMB~(2,909+308US$)Withadequatetraining,CarotidEndart
8、erectomy(CEA)inChinaisverysafeandeffectiveCEAinUSA:>200,000cases/yearCEAinChina:<200cases/yearWhysofewCEAinChina?NoformaltrainingPooroutcomes(inthepast)
