Spence J David, Coates Victoria, Li Hector, Tamayo Arturo, Muñoz Claudio, Hackam Daniel G, DiCicco Maria, DesRoches Janine, Bogiatzi Chrysi, Klein Jonathan, Madrenas Joaquim, Hegele Robert A
Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Road, London, Ontario, Canada.
Arch Neurol. 2010 Feb;67(2):180-6. doi: 10.1001/archneurol.2009.289. Epub 2009 Dec 14.
To assess the effect of more intensive medical therapy on the rate of transcranial Doppler (TCD) microemboli and cardiovascular events in patients with asymptomatic carotid stenosis (ACS).
A prospective study.
A teaching hospital.
Four hundred sixty-eight patients with ACS greater than 60% by Doppler peak velocity.
We compared (1) the proportion of ACS patients who had microemboli on TCD, (2) cardiovascular events, (3) rate of carotid plaque progression, and (4) baseline medical therapy, before and since 2003.
Among 468 ACS patients, 199 were enrolled between January 1, 2000, and December 31, 2002; and 269 were enrolled between January 1, 2003, and July 30, 2007. Microemboli were present in 12.6% before 2003 and 3.7% since 2003 (P < .001). The decline in microemboli coincided with better control of plasma lipids and slower progression of carotid total plaque area. Since 2003, there have been significantly fewer cardiovascular events among patients with ACS: 17.6% had stroke, death, myocardial infarction, or carotid endarterectomy for symptoms before 2003, vs 5.6% since 2003 (P < .001). The rate of carotid plaque progression in the first year of follow-up has declined from 69 mm(2) (SD, 96 mm(2)) to 23 mm(2) (SD, 86 mm(2)) (P < .001).
Cardiovascular events and microemboli on TCD have markedly declined with more intensive medical therapy. Less than 5% of patients with ACS now stand to benefit from revascularization; patients with ACS should receive intensive medical therapy and should only be considered for revascularization if they have microemboli on TCD.
评估强化药物治疗对无症状性颈动脉狭窄（ACS）患者经颅多普勒（TCD）微栓子发生率及心血管事件的影响。
一项前瞻性研究。
一家教学医院。
468例经多普勒峰值流速显示颈动脉狭窄超过60%的ACS患者。
我们比较了（1）TCD显示有微栓子的ACS患者比例，（2）心血管事件，（3）颈动脉斑块进展率，以及（4）2003年之前和之后的基线药物治疗情况。
在468例ACS患者中，199例于2000年1月1日至2002年12月31日入组；269例于2003年1月1日至2007年7月30日入组。2003年之前微栓子发生率为12.6%，2003年之后为3.7%（P < .001）。微栓子的减少与血脂控制改善及颈动脉总斑块面积进展减缓相一致。2003年之后，ACS患者的心血管事件显著减少：2003年之前，17.6%的患者出现中风、死亡、心肌梗死或因症状行颈动脉内膜切除术，而2003年之后为5.6%（P < .001）。随访第一年颈动脉斑块进展率从69平方毫米（标准差，96平方毫米）降至23平方毫米（标准差，86平方毫米）（P < .001）。
强化药物治疗使心血管事件和TCD微栓子显著减少。现在不到5%的ACS患者可能从血运重建中获益；ACS患者应接受强化药物治疗，只有TCD显示有微栓子的患者才应考虑血运重建。
