THE NATURAL-HISTORY OF ASYMPTOMATIC CAROTID-ARTERY DISEASE
THE NATURAL-HISTORY OF ASYMPTOMATIC CAROTID-ARTERY DISEASE
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DOI：
10.1016/0741-5214(93)90020-m
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发表时间：
1993-01-01
影响因子：
4.3
通讯作者：
GREENHALGH, RM
中科院分区：
文献类型：
--
作者：
BOCK, RW;GRAYWEALE, AC;GREENHALGH, RM
目的：本文的目的是确定颈动脉疾病的自然史无症状患者颈部杂音或其他危险因素的中风和研究价值的多普勒超声在预测未来的神经系统events.Methods：242无症状，未手术的患者，无症状的颈动脉疾病的评价，进行了前瞻性随访与多普勒超声。在平均27.4个月的随访中，34例患者发生了15例缺血性卒中（6.2%）和20例短暂性脑缺血发作（TIA）（8.3%）。卒中、TIA和联合事件的年发生率分别为2.7%、3.6%和6.2%。尽管病变占80%-99%的患者的年事件发生率为20.6%，但大多数事件发生在这些病变的对侧; 80%-99%病变的血管特异性年事件发生率为5。百分之一15例卒中中只有1例发生在80%至99%狭窄的同侧。回声斑块与TIA和卒中相关（年血管事件率为5.7%，回声斑块为2.4%，p = 0.03）。疾病进展与TIA和卒中高度相关（p < 0.0001），但通常与缺血性事件相关而不是在缺血性事件之前发生，因此证明在解释发病机制方面比预测未来事件更有用。阿司匹林的使用与短暂性脑缺血发作之间没有关联，但服用阿司匹林的患者每年的中风率要高出三倍（1.6% vs 4.8%，p = 0.027）。这项研究，虽然证实了无症状的严重狭窄或回声斑块患者的显着风险，证明了对侧疾病的重要性，以及缺乏从轻微疾病到高度疾病的有序进展，分级狭窄至症状性脑缺血。TIA和中风通常与颈动脉疾病的突然、不可预测的量子变化相关。
Purpose: The purpose of this article is to determine the natural history of carotid artery disease among asymptomatic patients with cervical bruits or other risk factors for stroke and to study the value of duplex ultrasonography in predicting future neurologic events.Methods: Two hundred forty-two asymptomatic, unoperated patients, referred for evaluation of asymptomatic carotid artery disease, were followed prospectively with duplex ultrasonography.Results: Fifteen ischemic strokes (6.2%) and 20 transient ischemic attacks (TIA) (8.3%) occurred in 34 patients during a mean follow-up of 27.4 months. Annual stroke, TIA, and combined event rates were 2.7%, 3.6%, and 6.2%, respectively. Although patients with 80% to 99% lesions had a 20.6% annual event rate, most events occurred contralateral to these lesions; the vessel-specific annual event rate for 80% to 99% disease was 5. 1%. Only one of 15 strokes occurred ipsilateral to an 80% to 99% stenosis. Echolucent plaques were associated with TIA and stroke (5.7% annual vessel event rate vs 2.4% for echogenic plaques, p = 0.03). Disease progression was highly correlated with TIA and stroke (p < 0.0001), but it usually occurred in association with rather than before ischemic events, thus proving more useful in explaining pathogenesis than in predicting future events. There was no association between aspirin use and TIA, but patients taking aspirin had a threefold higher annual stroke rate (1.6% vs 4.8%, p = 0.027).Conclusions: This study, while confirming significant risk for asymptomatic patients with critical stenosis or echolucent plaque, demonstrates the importance of contralateral disease and the absence of orderly progression from minimal disease through high-grade stenosis to symptomatic cerebral ischemia. TIA and stroke commonly occur in association with abrupt, unpredictable, quantum changes in carotid artery disease.