The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis
The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis
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DOI：
10.1056/nejm200006083422302
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发表时间：
2000-06-08
影响因子：
158.5
通讯作者：
Barnett, HJM
中科院分区：
文献类型：
--
作者：
Inzitari, D;Eliasziw, M;Barnett, HJM
背景：无症状颈动脉狭窄患者卒中的原因尚未得到仔细研究。有关原因的信息可能会影响使用颈动脉内膜切除术在这样的patients.Methods的决定：我们研究了1988年至1997年的单侧症状性颈动脉狭窄和无症状对侧狭窄的患者。的原因，严重程度，风险，和预测中风的领土上的无症状artery.Results：中风的风险在五年后的研究进入共1820例狭窄的严重程度增加。在1604例狭窄小于管腔直径60%的患者中，首次卒中的风险为8.0%（每年1.6%），而在216例狭窄60%至99%的患者中，首次卒中的风险为16.2%（每年3.2%）。在60%至99%狭窄的组中，大动脉区域中风的五年风险为9.9%，腔隙性中风为6.0%，心源性栓塞性中风为2.1%。一些患者有一个以上的中风的一个以上的原因。在无症状闭塞动脉的区域（在86例患者中确定），卒中的年化风险为1.9%。不同病因的脑卒中有不同的危险因素。大动脉卒中的危险因素为无症状性脑梗死、糖尿病史和较高程度的狭窄;心源性卒中的危险因素为心肌梗死或心绞痛和高血压史;腔隙性卒中的危险因素为年龄≥ 75岁、高血压、糖尿病和较高程度的狭窄。在无症状狭窄为60%至99%的患者中，45%的中风可归因于腔隙或心源性栓塞。这些观察结果对无症状患者动脉内膜切除术的使用有意义。如果不根据病因分析卒中风险，动脉内膜切除术的绝对获益可能被高估。（N Engl J Med 2000;342：1693-700。）(C)2000年，马萨诸塞州医学会。
Background: The causes of stroke in patients with asymptomatic carotid-artery stenosis have not been carefully studied. Information about causes might influence decisions about the use of carotid endarterectomy in such patients.Methods: We studied patients with unilateral symptomatic carotid-artery stenosis and asymptomatic contralateral stenosis from 1988 to 1997. The causes, severity, risk, and predictors of stroke in the territory of the asymptomatic artery were examined and quantified.Results: The risk of stroke at five years after study entry in a total of 1820 patients increased with the severity of stenosis. Among 1604 patients with stenosis of less than 60 percent of the luminal diameter, the risk of a first stroke was 8.0 percent (1.6 percent annually), as compared with 16.2 percent (3.2 percent annually) among 216 patients with 60 to 99 percent stenosis. In the group with 60 to 99 percent stenosis, the five-year risk of stroke in the territory of a large artery was 9.9 percent, that of lacunar stroke was 6.0 percent, and that of cardioembolic stroke 2.1 percent. Some patients had more than one stroke of more than one cause. In the territory of an asymptomatic occluded artery (as was identified in 86 patients), the annualized risk of stroke was 1.9 percent. Strokes with different causes had different risk factors. The risk factors for large-artery stroke were silent brain infarction, a history of diabetes, and a higher degree of stenosis; for cardioembolic stroke, a history of myocardial infarction or angina and hypertension; and for lacunar stroke, age of 75 years or older, hypertension, diabetes, and a higher degree of stenosis.Conclusions: The risk of stroke among patients with asymptomatic carotid-artery stenosis is relatively low. Forty-five percent of strokes in patients with asymptomatic stenosis of 60 to 99 percent are attributable to lacunes or cardioembolism. These observations have implications for the use of endarterectomy in asymptomatic patients. Without analysis of the risk of stroke according to cause, the absolute benefit associated with endarterectomy may be overestimated. (N Engl J Med 2000;342:1693-700.) (C) 2000, Massachusetts Medical Society.