Benign prognosis of never-symptomatic carotid occlusion
Benign prognosis of never-symptomatic carotid occlusion
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DOI：
10.1212/wnl.54.4.878
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发表时间：
2000-02-22
期刊：
影响因子：
9.9
通讯作者：
Grubb, RL
中科院分区：
文献类型：
--
作者：
Powers, WJ;Derdeyn, CP;Grubb, RL
目的：确定无症状颈动脉闭塞的预后。背景：与有症状的颈动脉闭塞相反，关于无症状颈动脉闭塞的预后的信息很少。方法：对 30 名无症状和 81 名有症状的颈动脉闭塞患者进行了 15 个危险因素的基线评估以及氧提取分数的 PET 测量。 （OEF）。在平均 32 个月的随访期间，每 B 个月的电话联系都会记录间隔医疗和随后的中风发生情况。患者、治疗医生和终点裁决者对 PET 结果不知情。结果：30 名无症状患者中有 1 名（3.3%）发生缺血性卒中，81 名有症状患者中有 15 名（18.5%；p = 0.03）发生缺血性卒中，无症状患者中闭塞血管远端的颈动脉区域没有发生卒中。对所有 111 名患者的基线危险因素进行的多变量分析显示，年龄、血浆纤维蛋白原水平和闭塞颈动脉远端高 OEF 的 PET 结果是后续卒中的唯一独立预测因素 (p < 0.05)。既往同侧半球或视网膜症状并不是显着的预测变量。与有症状患者（81 人中的 39 人；p = 0.002）相比，无症状患者中风的风险较低，与高 OEF 发生率较低（30 人中的 4 人）相关，但年龄或纤维蛋白原水平没有显着差异。结论：无症状的颈动脉闭塞随后发生缺血性中风的风险非常低。这种良性预后与这些患者脑血流动力学损害的发生率较低有关。这些数据进一步支持了血流动力学因素在颈动脉闭塞患者缺血性卒中发病机制中的重要性。
Objective: To determine the prognosis of asymptomatic carotid artery occlusion. Background: As opposed to symptomatic carotid occlusion, little information is available on the prognosis of asymptomatic carotid occlusion. Method: Thirty never-symptomatic and 81 symptomatic patients with carotid occlusion underwent baseline assessment of 15 risk factors together with PET measurements of oxygen extraction fraction. (OEF). Every B-month telephone contact recorded interval medical treatment and subsequent stroke occurrence during an average follow-up of 32 months. Patients, treating physicians, and an end point adjudicator were blinded to PET results. Results: Ischemic stroke occurred in 1 of 30 of never-symptomatic patients (3.3%) and 15 of 81 of symptomatic patients (18.5%; p = 0.03), No strokes in the carotid territory distal to the occluded vessel occurred in the never-symptomatic patients. Multivariate analysis of baseline risk factors for all 111 patients revealed that age, plasma fibrinogen level, and PET findings of high OEF distal to the occluded carotid artery were the only independent predictors of subsequent stroke (p < 0.05). Previous ipsilateral hemispheric or retinal symptoms was not a significant predictive variable. The lower risk of stroke in never-symptomatic patients was associated with a lower incidence of high OEF (4 of 30) as opposed to symptomatic patients (39 of 81; p = 0.002), but there was no significant difference in age or fibrinogen level. Conclusions: Never-symptomatic carotid occlusion carries a very low risk of subsequent ischemic stroke. This benign prognosis is associated with a low incidence of cerebral hemodynamic compromise in these patients. These data support further the importance of hemodynamic factors in the pathogenesis of ischemic stroke in patients with carotid occlusion.