Progression of carotid disease after endarterectomy: A Doppler ultrasound study
Progression of carotid disease after endarterectomy: A Doppler ultrasound study
复制标题
颈动脉内膜切除术后颈动脉疾病的进展：多普勒超声研究
作者：
B. Norrving;B. Nilsson;J. Olsson
单侧动脉内膜切除术后的颈动脉病变的临床预后和演变进行了测定，在64例患者检查术后1至13年（平均观察期，6年）。手术主要局限于仅在适当侧狭窄的有症状的患者。手术侧的平均年卒中率为1.6%，非手术侧为0.8%。随访时的直接多普勒检查显示36%的手术颈动脉复发性狭窄（≥50%）或闭塞，与非手术侧进行性颈动脉病变的比例（27%）无显著差异。总体而言，与既往血管造影结果相比，43.8%的患者在一侧或两侧颈动脉中出现新病变。约30%的进展性病变与短暂性脑缺血发作或卒中症状相关，而5.5%的血管无病变进展（p < 0.001）。手术侧复发性狭窄的发生率明显高于以前报道的症状性复发性狭窄，但可能代表了该人群颈动脉疾病的自然病程，因此颈动脉手术不应被视为确定性治疗。
The clinical prognosis and evolution of carotid lesions after unilateral endarterectomy were determined in 64 patients examined 1 to 13 years after surgery (mean observation period, 6 years). Surgery mainly was confined to symptomatic patients with a stenosis only on the appropriate side. Average annual stroke rate was 1.6% on the operated and 0.8% on the nonoperated side. Direct Doppler examination at follow‐up revealed a recurrent stenosis (≥50%) or occlusion in 36% of the operated carotid arteries, not significantly different from the proportion of progressive carotid lesions on the nonoperated side (27%). In total, 43.8% of the patients had developed new lesions in one or both carotid arteries, as compared to previous angiographic findings. About 30% of the progressive lesions were associated with symptoms of transient ischemic attacks or stroke, as opposed to 5.5% of vessels without progression of lesions (p < 0.001). The incidence of recurrent stenosis on the operated side is considerably higher than that previously reported for symptomatic recurrent stenosis, but may represent the natural course of carotid disease in this population, in which carotid surgery thus should not be regarded as definitive treatment.