Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%.
Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%.
复制标题
优化%20双工%20随访%20in%20患者%20与%20an%20无症状%20内部%20颈动脉%20动脉%20狭窄%20的%20少于%20%2060%。
DOI：
10.1067/mva.2001.112303
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发表时间：
2001
影响因子：
4.3
通讯作者：
Porter,JM
中科院分区：
文献类型：
--
作者：
Lovelace,TD;Moneta,GL;Abou-ZamzamJr,AM;Edwards,JM;Yeager,RA;Landry,GJ;TaylorJr,LM;Porter,JM
目的：无症状颈动脉粥样硬化研究证实了颈动脉内膜切除术对60%至99%的无症状颈内动脉狭窄患者的益处。检测ICA狭窄从< 60%到60%-99%进展的最佳随访间隔尚不清楚。在我们实验室之前的一项研究中，我们发现狭窄度< 60%且初始双工时峰值收缩速度（psv）为175 cm/s或更高的ICAs进展风险较高。本报告的基础是对该假设进行前瞻性评估，并确定< 60% ICA狭窄无症状患者的最佳双次随访时间间隔。方法：自1995年1月1日以来，所有首次接受颈动脉双工检查的患者，至少有一例无症状、既往未手术且狭窄< 60%的ICA；随访6个月或更长时间；并通过一次或多次重复双工检查进入研究。根据最初的双重检查，将ICAs分为两组：PSV小于175 cm/s和PSV大于或等于175 cm/s。以不同的间隔进行随访双重检查，以检测从< 60%到60%-99%的ICA狭窄进展，并符合先前报道的标准（PSV≥260 cm/s，舒张末期流速≥70 cm/s）。结果共407例患者（640例无症状ica狭窄< 60%）行连续双工扫描（平均随访22个月）。3例ICA（0.5%）在平均21个月（均为短暂性脑缺血发作）出现症状并进展为60%-99%的ICA狭窄，而其他4例ICA在随访期间未发生卒中。46例ica（7%）无症状进展到60%-99%狭窄（平均18个月）。在633条无症状动脉中，548条ica（87%）的初始psv小于175 cm/s， 85条ica（13%）的初始psv大于或等于175 cm/s。85例初始psv为175 cm/s或更高的ICAs中有22例（26%）无症状进展至60%-99%的ICA狭窄，而548例初始psv小于175 cm/s的ICAs中有24例（4%）进展（P < 0.0001）。Kaplan-Meier方法用于测定6个月、12个月和24个月时的进展自由度，对于初始psv为175 cm/s或更高的ICAs，分别为95%、83%和70%，而对于初始psv小于175 cm/s的ICAs，分别为100%、99%和95% （P < 0.0001）。结论：< 60% ICA狭窄和初始双工检查psv为175 cm/s或更高的患者更有可能无症状进展至60%-99% ICA狭窄，并且进展足够频繁，需要每隔6个月进行随访双工研究。< 60% ICA狭窄且初始psv小于175 cm/s的患者可以安全地延迟2年进行随访双重检查。（中华外科杂志2001；33:56-61）
ObjectivesThe Asymptomatic Carotid Atherosclerosis Study established benefit of carotid endarterectomy for 60% to 99% asymptomatic internal carotid artery (ICA) stenosis. Optimal follow-up intervals to detect progression from < 60% to 60%-99% ICA stenosis are unknown. In a previous study from our laboratory, we found that ICAs with < 60% stenosis and peak systolic velocities (PSVs) of 175 cm/s or more on initial duplex were at high risk for progression. Prospective evaluation of this hypothesis and determination of optimal duplex follow-up intervals for asymptomatic patients with < 60% ICA stenosis form the basis of this report.MethodsAll patients who underwent initial carotid duplex examination for any indication since January 1, 1995, with at least one patent, asymptomatic, previously nonoperated ICA with < 60% stenosis; with 6 months' or greater follow-up; and with one or more repeat duplex examinations were entered into the study. On the basis of the initial duplex examination, ICAs were classified into two groups: those with a PSV less than 175 cm/s and those with a PSV of 175 cm/s or more. Follow-up duplex examinations were performed at varying intervals to detect progression from < 60% to 60%-99% ICA stenosis with criteria previously reported (both PSV ≥ 260 cm/s and end-diastolic velocity ≥ 70 cm/s).ResultsA total of 407 patients (640 asymptomatic ICAs with < 60% stenosis) underwent serial duplex scans (mean follow-up, 22 months). Three ICAs (0.5%) became symptomatic and progressed to 60%-99% ICA stenosis at a mean of 21 months (all transient ischemic attacks), whereas four other ICAs occluded without stroke during follow-up. Progression to 60%-99% stenosis without symptoms was detected in 46 ICAs (7%) (mean, 18 months). Of the 633 patent asymptomatic arteries, 548 ICAs (87%) had initial PSVs less than 175 cm/s, and 85 ICAs (13%) had initial PSVs of 175 cm/s or more. Asymptomatic progression to 60%-99% ICA stenosis occurred in 22 (26%) of 85 ICAs with initial PSVs of 175 cm/s or more, whereas 24 (4%) of 548 ICAs with initial PSVs less than 175 cm/s progressed (P < .0001). The Kaplan-Meier method was used to determine freedom from progression at 6 months, 12 months, and 24 months, which was 95%, 83%, and 70% for ICAs with initial PSVs of 175 cm/s or more versus 100%, 99%, and 95%, respectively, for ICAs with initial PSVs less than 175 cm/s (P < .0001).ConclusionsPatients with < 60% ICA stenosis and PSVs of 175 cm/s or more on initial duplex examination are significantly more likely to progress asymptomatically to 60%-99% ICA stenosis, and progression is sufficiently frequent to warrant follow-up duplex studies at 6-month intervals. Patients with < 60% ICA stenosis and initial PSVs less than 175 cm/s may have follow-up duplex examinations safely deferred for 2 years. (J Vasc Surg 2001;33:56-61.)