Mayberg M R, Wilson S E, Yatsu F, Weiss D G, Messina L, Hershey L A, Colling C, Eskridge J, Deykin D, Winn H R
Department of Neurological Surgery, University of Washington, Seattle 98195.
JAMA. 1991 Dec 18;266(23):3289-94.
To determine whether carotid endarterectomy provides protection against subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant (greater than 50%) ipsilateral internal carotid artery stenosis.
Prospective, randomized, multicenter trial.
Sixteen university-affiliated Veterans Affairs medical centers.
Men who presented within 120 days of onset of symptoms that were consistent with transient ischemic attacks, transient monocular blindness, or recent small completed strokes between July 1988 and February 1991. Among 5000 patients screened, 189 individuals were randomized with angiographic internal carotid artery stenosis greater than 50% ipsilateral to the presenting symptoms. Forty-eight eligible patients who refused entry were followed up outside of the trial.
Cerebral infarction or crescendo transient ischemic attacks in the vascular distribution of the original symptoms or death within 30 days of randomization.
Carotid endarterectomy plus the best medical care (n = 91) vs the best medical care alone (n = 98).
At a mean follow-up of 11.9 months, there was a significant reduction in stroke or crescendo transient ischemic attacks in patients who received carotid endarterectomy (7.7%) compared with nonsurgical patients (19.4%), or an absolute risk reduction of 11.7% (P = .011). The benefit of surgery was more profound in patients with internal carotid artery stenosis greater than 70% (absolute risk reduction, 17.7%; P = .004). The benefit of surgery was apparent within 2 months after randomization, and only one stroke was noted in the surgical group beyond the 30-day perioperative period.
For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carotid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemia. The risk of cerebral ischemia in this subgroup of patients is considerably higher than previously estimated.
确定对于有明显（大于50%）同侧颈内动脉狭窄供血区域缺血症状的男性，颈动脉内膜切除术是否能预防随后的脑缺血。
前瞻性、随机、多中心试验。
16家大学附属退伍军人事务医疗中心。
1988年7月至1991年2月期间出现与短暂性脑缺血发作、短暂性单眼失明或近期小的完全性卒中相符症状的男性患者，症状出现后120天内就诊。在5000名筛查患者中，189例经血管造影显示同侧颈内动脉狭窄大于50%的患者被随机分组。48例符合条件但拒绝入组的患者在试验外进行随访。
在随机分组后30天内，原症状血管分布区域的脑梗死或进行性短暂性脑缺血发作或死亡。
颈动脉内膜切除术加最佳药物治疗（n = 91）对比单纯最佳药物治疗（ n = 98）。
平均随访11.9个月时，接受颈动脉内膜切除术的患者发生卒中或进行性短暂性脑缺血发作的比例（7.7%）与未手术患者（19.4%）相比显著降低，绝对风险降低11.7%（P = 0.011）。颈内动脉狭窄大于70%的患者手术获益更大（绝对风险降低17.7%；P = 0.004）。手术获益在随机分组后2个月内即显现，手术组在围手术期30天后仅记录到1例卒中。
对于一组选定的有大脑或视网膜缺血症状且存在重度颈内动脉狭窄供血区域的男性患者，颈动脉内膜切除术可有效降低随后同侧脑缺血的风险。该亚组患者的脑缺血风险比先前估计的要高得多。
