Cinà C S, Safar H A, Maggisano R, Bailey R, Clase C M
Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada.
J Vasc Surg. 2002 Jul;36(1):75-82. doi: 10.1067/mva.2002.123690.
The purpose of this study was to determine the prevalence of significant carotid stenosis, to identify risk factors increasing this prevalence, and to determine the risk of progression of stenosis, in patients with peripheral arterial occlusive disease who are neurologically asymptomatic.
Consecutive patients who underwent evaluation in a vascular laboratory for peripheral arterial occlusive disease, who had no recent neurologic symptoms, were investigated.
From July 1999 to December 2000, 620 patients underwent duplex scanning on one occasion, and 417 on two occasions. The average age was 72 +/- 10 years, and 61% were men. An occluded internal carotid artery was found in 4.8% of patients. The prevalence of a carotid stenosis >50% was 33% on the initial evaluation. Age of more than 70 years (P =.007), diabetes mellitus (P =.042), history of stroke (P =.011), and ankle/brachial index of less than 0.8 (P =.0006), were independently associated with carotid stenosis >50%. The odds ratio associated with each of these risk factors was similar. The prevalence of carotid stenosis >50% was 16%, 21%, 38%, 47%, and 44% for patients with no, one, two, three, and four risk factors, respectively. The highest prevalence of carotid stenosis >50% was identified in patients with ankle/brachial indices of less than 0.4 (59%). During the follow-up period, no patient had a cerebrovascular event. In 15% of carotid arteries, progression from one class of stenosis to a more severe class was observed, and 6.5% of patients progressed from a lower degree to 50% to 99% stenosis. No differences in progression of disease were identified when the variables of age, diabetes, previous stroke, and ankle/brachial index of less than 0.8 were studied or when patients with zero to two of these putative risk factors were compared with patients with three or four.
Screening for carotid stenosis in asymptomatic patients with peripheral vascular disease is justifiable, but not mandatory, when two or more risk factors are present or when the ankle/brachial index is less than 0.4. Rates of progression to clinically significant stenosis are low and do not justify reevaluation every 6 months. Further research to identify the optimal interval for reevaluation is needed.
本研究旨在确定无症状性外周动脉闭塞性疾病患者中重度颈动脉狭窄的患病率，识别增加该患病率的危险因素，并确定狭窄进展的风险。
对在血管实验室接受外周动脉闭塞性疾病评估且近期无神经症状的连续患者进行调查。
1999年7月至2000年12月，620例患者接受了一次双功超声扫描，417例患者接受了两次扫描。平均年龄为72±10岁，61%为男性。4.8%的患者发现颈内动脉闭塞。初次评估时，颈动脉狭窄>50%的患病率为33%。年龄超过70岁（P = 0.007）、糖尿病（P = 0.042）、中风史（P = 0.011）和踝臂指数小于0.8（P = 0.0006）与颈动脉狭窄>50%独立相关。与这些危险因素相关的比值比相似。无危险因素、有1个、2个、3个和4个危险因素的患者中，颈动脉狭窄>50%的患病率分别为16%、21%、38%、47%和44%。踝臂指数小于0.4的患者中，颈动脉狭窄>50%的患病率最高（59%）。随访期间，无患者发生脑血管事件。15%的颈动脉观察到狭窄程度从一类进展为更严重的一类，6.5%的患者从较低程度进展至50%至99%狭窄。在研究年龄、糖尿病、既往中风和踝臂指数小于0.8等变量时，或在比较有0至2个这些假定危险因素的患者与有3个或4个危险因素的患者时，未发现疾病进展有差异。
对于外周血管疾病无症状患者，当存在两个或更多危险因素或踝臂指数小于0.4时，筛查颈动脉狭窄是合理的，但非强制性。进展为临床显著狭窄的发生率较低，无需每6个月重新评估。需要进一步研究以确定重新评估的最佳间隔时间。
