Liapis C D, Kakisis J D, Kostakis A G
Second Department of Propedeutic Surgery, Athens University Medical School, Laiko Hospital, Athens, Greece.
Stroke. 2001 Dec 1;32(12):2782-6. doi: 10.1161/hs1201.099797.
The ability to predict future strokes in asymptomatic patients with carotid stenosis is currently limited. The management of symptomatic patients with <50% stenosis is also debatable. In this context, we performed the following open prospective study to identify factors affecting symptomatology in patients with carotid stenosis.
During 1988-1997, 442 arteries with various degrees of stenosis were followed with the use of color Duplex ultrasonography every 6 months. The main outcome measures were development of symptoms related to the carotid territory and progression in the degree of stenosis. Results of follow-up were analyzed in relation to the traditional risk factors for atherosclerosis as well as the ultrasonographic characteristics of the plaques. Statistical analysis was performed by multiple linear and Cox regression analysis.
Mean duration of follow-up was 44 months (range, 12 to 120 months). Significant progression of stenosis occurred in 18.5% of the cases and was more frequent in younger patients (P=0.09), in patients with coronary artery disease (P=0.02), and in patients with echolucent plaques (P=0.02). In regard to clinical presentation, men (P=0.07), hypertensives (P=0.07), and patients with echolucent plaques (P=0.09) showed a trend toward higher frequency of stroke in their history. During the follow-up period, neurological events developed in 12.4% of the cases and were associated with the severity of carotid disease (P<0.001), history of neurological events (P=0.02), progression of stenosis (P=0.002), echolucent plaques (P=0.01), and hypertension (P=0.02).
Factors other than degree of stenosis and history of neurological events are also important in determining high-risk carotid plaque. In our study hypertension, echolucent plaques, and progressive lesions were associated with an increased risk of neurological events. These factors should be taken into consideration in determining treatment strategies for carotid stenosis.
目前,预测无症状性颈动脉狭窄患者未来发生卒中的能力有限。对于狭窄程度小于50%的有症状患者的治疗也存在争议。在此背景下,我们开展了以下开放性前瞻性研究,以确定影响颈动脉狭窄患者症状的因素。
在1988年至1997年期间,对442条不同程度狭窄的动脉每6个月进行一次彩色双功超声检查随访。主要观察指标为与颈动脉供血区域相关症状的出现以及狭窄程度的进展。根据动脉粥样硬化的传统危险因素以及斑块的超声特征对随访结果进行分析。采用多元线性回归和Cox回归分析进行统计学分析。
平均随访时间为44个月(范围12至120个月)。18.5%的病例出现了明显的狭窄进展,在年轻患者(P = 0.09)、冠心病患者(P = 0.02)和有低回声斑块的患者(P = 0.02)中更常见。关于临床表现,男性(P = 0.07)、高血压患者(P = 0.07)和有低回声斑块的患者(P = 0.09)既往卒中发生率有升高趋势。在随访期间,12.4%的病例发生了神经事件,且与颈动脉疾病的严重程度(P < 0.001)、神经事件史(P = 0.02)、狭窄进展(P = 0.002)、低回声斑块(P = 0.01)和高血压(P = 0.02)相关。
除狭窄程度和神经事件史外,其他因素在确定高危颈动脉斑块方面也很重要。在我们的研究中,高血压、低回声斑块和进展性病变与神经事件风险增加相关。在确定颈动脉狭窄的治疗策略时应考虑这些因素。