Nearing the finish line? The asymptomatic Carotid Atherosclerosis Study.
Nearing the finish line? The asymptomatic Carotid Atherosclerosis Study.
复制标题
接近终点线了吗？
DOI：
10.1161/01.str.23.8.1054
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发表时间：
1992
期刊：
影响因子：
8.3
通讯作者：
Chambless,LE
中科院分区：
文献类型：
--
作者：
Toole,JF;Hobson2nd,RW;Howard,VJ;Chambless,LE
超过 1,200 名患者已被随机纳入无症状颈动脉粥样硬化研究 (ACAS)1，并且招募继续以每月约 30 名的速度进行。回答这个问题所需的计算样本量为 1500：“除了最佳医疗管理和每日 325 毫克阿司匹林之外，动脉内膜切除术是否可以显着降低随机动脉一侧短暂性脑缺血发作和中风的发生率？”欧洲颈动脉手术试验 (ECST) 和北美症状性颈动脉内膜切除术试验 (NASCET) 令人信服地证明，对有短暂性脑缺血发作 (TIA) 或轻微中风记录的患者进行手术治疗对于狭窄狭窄的患者是有益的。在这些研究中，即使高剂量的阿司匹林也不能替代动脉内膜切除术。这使得确定“有症状”人群的结果是否也可以转化为“无症状”人群变得尤为紧迫。两项多中心无症状动脉内膜切除术试验已结束招募。 2 无症状狭窄颈动脉狭窄：手术与阿司匹林 (CASANOVA) 研究于 1985 年 12 月完成了 410 名患者的随机分组。 3 治疗组之间的神经功能缺损和死亡人数没有显着差异，但研究设计并不是真正对颈动脉内膜切除术加药物治疗与单独药物治疗进行直接比较。手术组可以进行单侧或双侧动脉内膜切除术；单侧手术的患者，如果对侧狭窄进展到50%以上，则需进行第二次手术。医疗组中的患者没有因单侧狭窄而接受手术，但如果狭窄是双侧的，则患者在狭窄程度较大的一侧进行手术。如果狭窄进展至超过 90%，或双侧狭窄进展至超过 50%，则医疗组患者将接受动脉内膜切除术。这
More than 1,200 patients have been randomized into the Asymptomatic Carotid Atherosclerosis Study (ACAS), 1 and recruitment continues at a rate of about 30 per month. Fifteen hundred is the calculated sample size needed to answer the question," Does endarterectomy in addition to best medical management and 325 mg aspirin daily significantly reduce the incidence of transient ischemic attack and stroke on the side of the randomized artery?" The European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) have demonstrated convincingly that the surgical management of patients with documented transient ischemic attacks (TIAs) or minor strokes is beneficial for those who have a tight stenosis. In these studies, aspirin even in high doses did not substitute for endarterectomy. This adds particular urgency to the determination of whether the results in this" symptomatic" population can also be translated to those who are" asymptomatic." Two multicenter asymptomatic endarterectomy trials have closed recruitment. 2 The Carotid Artery Stenosis with Asymptomatic Narrowing: Operation Versus Aspirin (CASANOVA) study completed randomization of 410 patients in December 1985. 3 No significant difference in the number of neurological deficits and deaths was noted between the treatment groups, but the study design was not really a direct comparison of carotid endarterectomy plus medical management versus medical management alone. The surgical group could have either unilateral or bilateral endarterectomy; those patients having unilateral operation were to have a second operation if the contralateral side progressed to more than 50% stenosis. Patients in the medical group were not operated on for unilateral stenosis, but if the stenoses were bilateral, patients had surgery on the more stenosed side. Patients in the medical group had an endarterectomy if the stenosis progressed to more than 90%, or progressed bilaterally to greater than 50% stenoses. This