THE NATURAL-HISTORY OF CAROTID ARTERIAL-DISEASE IN ASYMPTOMATIC PATIENTS WITH CERVICAL BRUITS
THE NATURAL-HISTORY OF CAROTID ARTERIAL-DISEASE IN ASYMPTOMATIC PATIENTS WITH CERVICAL BRUITS
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DOI：
10.1161/01.str.15.4.605
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发表时间：
1984-01-01
期刊：
影响因子：
8.3
通讯作者：
STRANDNESS, DE
中科院分区：
文献类型：
--
作者：
ROEDERER, GO;LANGLOIS, YE;STRANDNESS, DE
1980年1月开始了一项前瞻性研究，对167名无症状的颈椎挫伤患者进行了连续的双工扫描。患者在第一年每隔6个月进行一次检查，此后每年一次。根据先前验证的标准，将颈动脉分叉处的疾病分为6类：正常，直径减少1-15%，16-49%,50-79%，80-99%和闭塞。对患者进行评估，以评估：新的神经系统症状的发生，颈动脉分叉处病变的稳定性以及危险指标对疾病变化的可能作用。随访期间，10例患者出现症状（6例为短暂性脑缺血发作，4例为脑卒中）。8例患者出现症状并伴有疾病进展。通过生命表分析，症状年发生率为4%。疾病进展至bb50 %狭窄的平均年发生率为8%。当考虑到所有类别的进展时，60%的侧壁表现出一定程度的疾病加重。狭窄的存在或进展到bbb80 %与颈内动脉完全闭塞或新症状的发展高度相关（P = 0.00001）。与疾病进展相关的主要危险因素是吸烟、糖尿病和年龄。65岁以下的患者最有可能出现进展。尽管疾病进展率很高，但本研究进一步支持这样一种观点，即在治疗无症状的颈椎损伤患者时，采用保守治疗是谨慎的。手术治疗可以延迟到TIA出现或疾病进展到bbb80 %狭窄。
A prospective study was initiated in Jan. 1980 to follow with Duplex scanning a consecutive series of 167 asymptomatic patients with cervical bruits. Patients were seen at 6 mo. intervals for the 1st yr and yearly thereafter. Based on previously validated criteria, disease at the carotid bifurcation was classified into 6 categories: Normal, 1-15% diameter reduction, 16-49%, 50-79%, 80-99% and occlusion. Patients were evaluated to assess: the occurrence of new neurological symptoms, the stability of the lesions at the carotid bifurcation and the possible role of risk indicators on disease changes. During follow-up, 10 patients became symptomatic (6 with TIA [transient ischemic attack] and 4 with stroke). The development of symptoms was accompanied by disease progression in 8 patients. By life table analysis, the annual rate occurrence of symptoms was 4%. The mean annual rate of disease progression to a > 50% stenosis was 8%. When progression in all categories was considered, 60% of the sides showed some disease aggravation. The presence of or progression to a > 80% stenosis was highly correlated (P = 0.00001) with either the development of a total occlusion of the internal carotid artery or new symptoms. The major risk factors associated with disease progression were cigarette smoking, diabetes mellitus and age. Those patients under 65 yr of age were most likely to show progression. Despite high rates of disease progression, this study further supports the contention that it is prudent to follow a conservative course in the management of asymptomatic patients presenting with a cervical bruit. Surgical treatment can be delayed until the appearance of TIA or progression of disease to a > 80% stenosis.