Fairhead J F, Mehta Z, Rothwell P M
University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, OX2 6HE, UK.
Neurology. 2005 Aug 9;65(3):371-5. doi: 10.1212/01.wnl.0000170368.82460.b4.
Benefit from carotid endarterectomy is greatest when performed within 2 weeks of a presenting TIA or stroke and decreases rapidly thereafter.
To determine the delays to carotid imaging and endarterectomy in Oxfordshire, UK, and the consequences for the effectiveness of stroke prevention.
All patients undergoing carotid imaging for ischemic retinal or cerebral TIA or stroke were identified in two populations: the population of Oxfordshire, UK (n = 680,772), from April 1, 2002, to March 31, 2003, and the Oxford Vascular Study (OXVASC) subpopulation (n = 92,000) from April 1, 2002, to March 31, 2004. The times from presenting event to referral, scanning, and endarterectomy (Oxfordshire population) and the risk of stroke prior to endarterectomy in patients with > or = 50% symptomatic carotid stenosis (OXVASC population) were determined.
Among 853 patients who had carotid imaging in the Oxfordshire population, median (interquartile range) times from presenting event to referral, scanning, and endarterectomy were 9 (3 to 30), 33 (12 to 62), and 100 (59 to 137) days. Eighty-five patients were found to have 50 to 99% symptomatic stenosis, of whom 49 had endarterectomy. Only 3 (6%) had surgery within 2 weeks of their presenting event and only 21 (43%) within 12 weeks. The risk of stroke prior to endarterectomy in the OXVASC subpopulation with > or = 50% stenosis was 21% (8 to 34%) at 2 weeks and 32% (17 to 47%) at 12 weeks, in half of which strokes were disabling or fatal.
Delays to carotid imaging and endarterectomy after TIA or stroke in the United Kingdom are similar to those reported in several other countries and are associated with very high risks of otherwise preventable early recurrent stroke.
颈动脉内膜切除术在出现短暂性脑缺血发作（TIA）或中风后2周内进行时获益最大，此后获益迅速下降。
确定英国牛津郡进行颈动脉成像和颈动脉内膜切除术的延迟情况，以及对预防中风有效性的影响。
在两个群体中识别出所有因缺血性视网膜或脑TIA或中风接受颈动脉成像的患者：2002年4月1日至2003年3月31日期间的英国牛津郡人群（n = 680,772），以及2002年4月1日至2004年3月31日期间的牛津血管研究（OXVASC）亚组人群（n = 92,000）。确定了从出现症状到转诊、扫描和颈动脉内膜切除术的时间（牛津郡人群），以及症状性颈动脉狭窄≥50%的患者在颈动脉内膜切除术之前的中风风险（OXVASC人群）。
在牛津郡人群中接受颈动脉成像的853例患者中，从出现症状到转诊、扫描和颈动脉内膜切除术的中位（四分位间距）时间分别为9（3至30）天、33（12至62）天和100（59至137）天。发现85例患者有50%至99%的症状性狭窄，其中49例接受了颈动脉内膜切除术。只有3例（6%）在出现症状后2周内接受了手术，只有21例（43%）在12周内接受了手术。在症状性颈动脉狭窄≥50%的OXVASC亚组中，颈动脉内膜切除术之前2周的中风风险为21%（8%至34%），12周时为32%（17%至47%），其中一半的中风导致残疾或死亡。
英国TIA或中风后进行颈动脉成像和颈动脉内膜切除术的延迟情况与其他几个国家报告的情况相似，并且与原本可预防的早期复发性中风的非常高风险相关。
