Jahromi Afshin S, Clase Catherine M, Maggisano Robert, Bailey Robin, Safar Hussein A, Cinà Claudio S
Division of Vascular Surgery, Guelph General Hospital, Hamilton, Ontario, Canada.
J Vasc Surg. 2009 Aug;50(2):292-8. doi: 10.1016/j.jvs.2009.02.236.
To study the risk factors and rate of progression of asymptomatic carotid stenosis in patients with peripheral arterial occlusive disease.
Between July 1999 and September 2003, we studied consecutive patients referred to a vascular laboratory for peripheral arterial occlusive disease who had not experienced neurologic symptoms within the previous 3 years. Carotid duplex ultrasound scan (DUS) was performed at baseline and at 6 to 12-month intervals. The internal carotid artery peak systolic velocity (PSV) was used to determine severity of carotid stenosis. Multilevel linear regression modeling (MLM) was used to identify the rate of progression and risk factors for progression.
For 614 consecutive patients, median follow-up by DUS was 30 (2-42) months. Patients were 73 +/- 10-years-old, and 62% were men. Mean ankle-brachial index (ABI) was 0.79 +/- 0.24. The baseline prevalence of carotid stenosis >or=50% (PSV >or=125 cm/second) was 22%. During follow-up, ipsilateral amaurosis fugax, transient ischemic attacks, and strokes occurred in 3 (0.4%), 7 (1.1%), and 5 (0.8%) patients, respectively. Overall, there was little progression in carotid stenosis. Female gender, low ABI, and smoking were risk factors for progression of disease regardless of severity of carotid stenosis. Patients with >or=50% carotid stenosis were at greatest risk of progression if they continued smoking and were diabetic. Prediction models for progression of carotid stenosis given a baseline PSV and patient risk factors were constructed.
There are few neurologic events in patients with asymptomatic carotid stenosis. The average rate of progression of stenosis over 2 years is not significant but greater in diabetic patients with baseline stenosis >50% who continue smoking. Rescreening by serial DUS should be limited to high-grade stenosis and follow-up performed at an interval of 1-2 years.
研究外周动脉闭塞性疾病患者无症状性颈动脉狭窄的危险因素及疾病进展速率。
1999年7月至2003年9月期间，我们对连续转诊至血管实验室的外周动脉闭塞性疾病患者进行了研究，这些患者在过去3年内未出现神经系统症状。在基线时以及每隔6至12个月进行一次颈动脉双功超声扫描（DUS）。利用颈内动脉收缩期峰值流速（PSV）来确定颈动脉狭窄的严重程度。采用多水平线性回归模型（MLM）来确定疾病进展速率及进展的危险因素。
对于614例连续患者，DUS的中位随访时间为30（2 - 42）个月。患者年龄为73±10岁，62%为男性。平均踝臂指数（ABI）为0.79±0.24。颈动脉狭窄≥50%（PSV≥125 cm/秒）的基线患病率为22%。在随访期间，分别有3例（0.4%）、7例（1.1%）和5例（0.8%）患者出现同侧一过性黑矇、短暂性脑缺血发作和中风。总体而言，颈动脉狭窄进展甚微。无论颈动脉狭窄的严重程度如何，女性、低ABI和吸烟都是疾病进展的危险因素。颈动脉狭窄≥50%的患者如果继续吸烟且患有糖尿病，则疾病进展风险最大。构建了根据基线PSV和患者危险因素预测颈动脉狭窄进展的模型。
无症状性颈动脉狭窄患者发生神经系统事件的情况较少。狭窄在2年期间的平均进展速率不显著，但在基线狭窄>50%且继续吸烟的糖尿病患者中进展速率更高。通过连续DUS进行重新筛查应限于高度狭窄患者，并以1 - 2年的间隔进行随访。
