Causes and severity of ischemic stroke in patients with internal carotid artery stenosis
Causes and severity of ischemic stroke in patients with internal carotid artery stenosis
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DOI：
10.1001/jama.283.11.1429
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发表时间：
2000-03-15
影响因子：
120.7
通讯作者：
Meldrum, H
中科院分区：
文献类型：
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作者：
Barnett, HJM;Gunton, RV;Meldrum, H
治疗试验通常没有根据病因区分中风的结果。目的探讨不同程度有症状和无症状的颈动脉狭窄患者卒中及继发残疾是大动脉、腔隙性还是心栓性。设计对1987 - 1997年间北美症状性颈动脉内膜切除术试验收集的前瞻性数据进行观察性研究。背景和患者来自美国和国外106个地点的2885例有症状性颈内动脉狭窄的患者（中位年龄67岁，70%为男性）。主要结局指标：按狭窄范围和程度划分的3种原因在5年内卒中的风险。结果平均随访5年，749例卒中发生1039例，其中心栓性卒中112例，腔隙性卒中211例，大动脉卒中698例，原发性脑出血17例，蛛网膜下腔出血1例。进入试验后，在任何地区首次中风的5年风险为心栓子原因的2.6%，腔隙性原因的6.9%和大动脉原因的19.7%。60% ~ 69%和70% ~ 99%动脉狭窄患者在症状性动脉范围内发生心栓子性卒中的比例分别为12.0%和6.9%；动脉狭窄70% ~ 99%以大动脉卒中为主（78.4%）。动脉狭窄70% ~ 99%，无症状和有症状的动脉源性心栓性和腔隙性卒中的比例分别为43.5%和21.6%。无症状动脉范围内的心栓塞性中风67.6%，腔隙性中风16.7%，大动脉中风33.0%致残或致死性。结论：我们的数据表明，大约20%和45%的卒中分别发生在有症状和无症状的颈动脉狭窄70%至99%的区域，与颈动脉狭窄无关。对于无症状性颈动脉狭窄患者进行颈动脉内膜切除术的治疗决策时，应考虑类似类型患者随后卒中的原因，因为腔隙性和心栓塞性卒中不能通过动脉内膜切除术预防。
Context Therapeutic trials generally have not distinguished outcomes of stroke according to cause.Objective To determine whether stroke and subsequent disability was of large-artery, lacunar, or cardioembolic origin in patients with different degrees of symptomatic and asymptomatic carotid stenosis.Design Observational study of prospective data collected from the North American Symptomatic Carotid Endarterectomy Trial between 1987 and 1997.Setting and Patients A total of 2885 patients from 106 sites in the United States and abroad (median age, 67 years; 70% male) who had symptomatic internal carotid artery stenosis.Main Outcome Measure Risk of stroke from each of the 3 causes at 5 years by territory and degree of stenosis.Results During an average follow-up of 5 years, 749 patients had 1039 strokes, including 112 of cardioembolic, 211 of lacunar, 698 of large-artery, 17 of primary intracerebral hemorrhage, and 1 of subarachnoid hemorrhage origin. The 5-year risk of first stroke after entry into the trial in any territory was 2.6% of cardioembolic cause, 6.9% of lacunar cause, and 19.7% of large-artery cause. The proportion of cardioembolic strokes in the territory of the symptomatic artery was 12.0% and 6.9% in 60% to 69% and 70% to 99% arterial stenosis, respectively; large-artery strokes predominated (78.4%) at 70% to 99% arterial stenosis. With 70% to 99% arterial stenosis, the proportion of strokes of cardioembolic and lacunar origin was 43.5% and 21.6% in asymptomatic and symptomatic arteries, respectively. A total of 67.6% of cardioembolic, 16.7% of lacunar, and 33.0% of large-artery strokes in the territory of the asymptomatic artery were disabling or fatal.Conclusions Our data suggest that approximately 20% and 45% of strokes in the territory of symptomatic and asymptomatic carotid arteries with 70% to 99% stenosis, respectively, are unrelated to carotid stenosis. The cause of subsequent strokes in similar types of patients should be considered when making treatment decisions involving carotid endarterectomy for patients with asymptomatic carotid stenosis, since lacunar and cardioembolic strokes cannot be prevented by endarterectomy.