Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques?
Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques?
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DOI：
10.1136/jnnp.2005.065821
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发表时间：
2005-12-01
影响因子：
11
通讯作者：
Hetzel, A
中科院分区：
文献类型：
--
作者：
Harloff, A;Handke, M;Hetzel, A
目的：本研究旨在探讨(A)动脉粥样硬化的卒中患者具有相似的颈动脉粥样硬化改变的假设，以及(B)颈动脉双功超声可替代经食道超声心动图(TEE)以排除或预测相关的主动脉斑块的可能性。方法：对301例急性脑缺血患者(平均年龄62岁)进行二维超声测量颈总动脉内中膜厚度(IMT)、最大斑块面积(PA)和颈内动脉(ICA)局部狭窄程度。结果：IMT=4 mm，NPV为100%。然而，IMT>；0.9 mm的阳性预测值很低(29.6%)，仅在存在颈动脉斑块时略有增加(33%)。当>；=50%时，主动脉血栓发生率显著高于=50%，且与AWT>；=4 mm独立相关。结论：正常颈动脉超声的高NPV不支持常规TEE排除复杂的主动脉斑块作为脑血栓的高危来源。然而，对于颈动脉粥样硬化的患者，特别是颈内动脉狭窄=50%的患者，应该进行TEE检查，以排除中风的另一个高危因素。
Objectives: This study investigated ( a) the hypothesis that stroke patients with aortic atheroma would show comparable atherosclerotic changes in the carotid arteries, which are easily accessible for ultrasound evaluation and (b) the possibility of carotid duplex sonography as a replacement for transoesophageal echocardiography ( TEE) for the exclusion or prediction of relevant aortic plaques.Methods: In 301 consecutive patients ( mean age 62 years) with acute cerebral ischaemia, two dimensional ultrasound measurements were taken of common carotid artery intima media thickness (IMT) and maximal plaque area (PA) and the local degree of internal carotid artery (ICA) stenosis were determined. Maximal aortic wall thickness (AWT) was assessed by TEE.Results: An IMT = 4 mm and an NPV of 100% for the exclusion of aortic thrombi. However, positive predictive value of IMT >0.9 mm was low (29.6%), increasing only slightly in the presence of carotid plaques (33%). Incidence of aortic thrombi was significantly higher with >= 50% compared with = 50% were independently related to AWT >= 4 mm.Conclusions: A high NPV of normal carotid ultrasound does not support routine TEE for the exclusion of complex aortic plaques as a high risk source of cerebral embolism. However, in patients with carotid atherosclerosis, particularly in those with ICA stenosis >= 50%, TEE should be performed to exclude an additional high risk source for stroke.