Fairhead Jack F, Rothwell Peter M
Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford OX2 6HE.
BMJ. 2006 Sep 9;333(7567):525-7. doi: 10.1136/bmj.38895.646898.55. Epub 2006 Jul 18.
To identify any underinvestigation of older patients with transient ischaemic attack (TIA) and stroke.
Comparative population based studies.
Routine clinical practice in all secondary care services in Oxfordshire and a nested population based study of incidence of transient ischaemic attack and stroke (the Oxford vascular study-OXVASC). PARTICIPANTS/POPULATION: All patients undergoing carotid imaging for ischaemic retinal or cerebral transient ischaemic attack or stroke from 1 April 2002 to 31 March 2005 in the Oxford vascular study (n = 91,105) and from 1 April 2002 to 31 March 2003 in routine clinical practice (n = 589,899).
Age specific rates of carotid imaging, diagnosed >or= 50% symptomatic carotid stenosis, and subsequent endarterectomy, in patients with recent transient ischaemic attack or stroke.
Of patients with recent carotid territory transient ischaemic attack or ischaemic stroke, 575 in routine clinical practice and 402 in the Oxford vascular study had carotid imaging, with similar rates up to the age of 80. The incidence of >or= 50% symptomatic stenosis increased steeply with age, particularly in those aged >or= 80. Compared with investigations in patients in the Oxford vascular study, the rates of carotid imaging (relative rate 0.36, 95% confidence interval 0.28 to 0.46, P < 0.0001), diagnosis of >or= 50% symptomatic stenosis (0.33, 0.16 to 0.69, P = 0.004), and carotid endarterectomy (0.19, 0.06 to 0.63, P = 0.007) in this age group in routine clinical practice were all substantially lower.
Incidence of symptomatic carotid stenosis increases steeply with age, but, despite good evidence of major benefit from endarterectomy in elderly patients and a willingness to have surgery, there is substantial underinvestigation in routine clinical practice in patients aged >or= 80 with transient ischaemic attack or ischaemic stroke.
确定老年短暂性脑缺血发作（TIA）和中风患者是否存在检查不足的情况。
基于人群的比较性研究。
牛津郡所有二级医疗服务机构的常规临床实践，以及一项基于人群的短暂性脑缺血发作和中风发病率的巢式研究（牛津血管研究 - OXVASC）。参与者/人群：2002年4月1日至2005年3月31日牛津血管研究中因缺血性视网膜或脑部短暂性脑缺血发作或中风接受颈动脉成像的所有患者（n = 91,105），以及2002年4月1日至2003年3月31日常规临床实践中的患者（n = 589,899）。
近期短暂性脑缺血发作或中风患者的年龄特异性颈动脉成像率、诊断为有症状性颈动脉狭窄≥50%以及随后的颈动脉内膜切除术率。
在常规临床实践中，近期有颈动脉供血区短暂性脑缺血发作或缺血性中风的患者中，有575人进行了颈动脉成像，在牛津血管研究中有402人进行了颈动脉成像，80岁及以下的患者成像率相似。有症状性狭窄≥50%的发病率随年龄急剧上升，特别是在80岁及以上的人群中。与牛津血管研究中的患者检查情况相比，常规临床实践中该年龄组的颈动脉成像率（相对率0.36，95%置信区间0.28至0.46，P < 0.0001）、诊断为有症状性狭窄≥50%的比例（0.33，0.16至0.69，P = 0.004）以及颈动脉内膜切除术率（0.19，0.06至0.63，P = 0.007）均显著较低。
有症状性颈动脉狭窄的发病率随年龄急剧上升，但尽管有充分证据表明老年患者行颈动脉内膜切除术有重大益处且患者愿意接受手术，但在常规临床实践中，80岁及以上的短暂性脑缺血发作或缺血性中风患者仍存在大量检查不足的情况。
