Silent embolic infarcts on computed tomography brain scans and risk of ipsilateral hemispheric events in patients with asymptomatic internal carotid artery stenosis
Silent embolic infarcts on computed tomography brain scans and risk of ipsilateral hemispheric events in patients with asymptomatic internal carotid artery stenosis
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DOI：
10.1016/j.jvs.2008.10.059
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发表时间：
2009-04-01
影响因子：
4.3
通讯作者：
Nicolaides, Andrew N.
中科院分区：
文献类型：
--
作者：
Kakkos, Stavros K.;Sabetai, Michael;Nicolaides, Andrew N.
目的：本研究验证了CT脑扫描无症状性栓塞性脑梗塞可以预测无症状颈内动脉狭窄患者的同侧神经半球事件和卒中的假设。方法：在一项前瞻性的多中心自然历史研究中，821例接受CT脑扫描的无症状颈动脉狭窄患者每6个月监测一次，最长持续8年。双向扫描是中央报告的，狭窄程度以北美症状性颈动脉内膜切除术试验者使用的正常颈内动脉远端标准的百分比表示。脑部CT扫描由一位神经放射科医生集中报告。在146例患者(17.8%)中，8例大皮质梗塞，15例小皮质梗塞，72例弥漫性皮质下梗塞和51例基底节梗塞；这些都被认为可能是栓塞性的，并被分类为栓塞性梗塞。结果：在平均44.6个月(6个月~8年)的随访中，102例患者发生了同侧大脑半球神经事件(16例发生黑色素沉着，38例短暂性脑缺血发作，47例中风)，138例死亡，24例失访。在狭窄程度为60%~99%的462例患者中，无栓塞性脑梗塞患者8年累积无事件发生率为0.81(年事件发生率为2.4%)，有栓塞性脑梗塞患者为0.63(年事件率4.6%)(对数等级P=0.032)。在359名患有糖尿病的患者中
Objectives: This study tested the hypothesis that silent embolic infarcts on computed tomography (CT) brain scans can predict ipsilateral neurologic hemispheric events and stroke in patients with asymptomatic internal carotid artery stenosis.Methods: In a prospective multicenter natural history study, 821 patients with asymptomatic carotid stenosis graded with duplex scanning who had CT brain scans were monitored every 6 months for a maximum of 8 years. Duplex scans were reported centrally, and stenosis was expressed as a percentage in relation to the normal distal internal carotid criteria used by the North American Symptomatic Carotid Endarterectomy Trialists. CT brain scans were reported centrally by a neuroradiologist. In 146 patients (17.8%), 8 large cortical, 15 small cortical, 72 discrete subcortical, and 51 basal ganglia ipsilateral infarcts were present; these were considered likely to be embolic and were classified as such. Other infarct types, lacunes (n=15), watershed (n=9), and the presence of diffuse white matter changes (n=95) were not considered to be embolic.Results: During a mean follow-up of 44.6 months (range, 6 months-8 years), 102 ipsilateral hemispheric neurologic events (amaurosis fugax in 16, 38 transient ischemic attacks [TIAs], and 47 strokes) occurred, 138 patients died, and 24 were lost to follow-up. In 462 patients with 60% to 99% stenosis, the cumulative event-free rate at 8 years was 0.81 (2.4% annual event rate) when embolic infarcts were absent and 0.63 (4.6% annual event rate) when present (log-rank P=.032). In 359 patients with