Neurology Department, Hospital Universitari del Mar, Passeig Marítim 25-29, 0003 Barcelona, Spain.
Stroke. 2011 Nov;42(11):3099-104. doi: 10.1161/STROKEAHA.110.612010. Epub 2011 Aug 18.
Data on the predictive value of carotid intima-media thickness (IMT) for stroke recurrence are scarce. We sought to analyze outcome differences in stroke patients with high IMT values compared with patients with significant carotid stenosis (SCS).
The multicenter observational ARTICO study included 620 independent patients older than 60 years with a first-ever noncardioembolic stroke. Patients were followed-up for 1 year. The primary end point was a composite of cardiovascular events and death. The IMT-ARTICO substudy analyzed ultrasonographic data from 599 patients. After Doppler carotid echography, patients were classified into the SCS group (carotid stenosis ≥50%; 117 cases), high IMT group (patients with the common carotid IMT in the highest quartile ≥1.11 mm and without SCS; 110 cases), and control group (stroke patients with an IMT <1.11 mm and without SCS; 372 cases). We analyzed the impact of both conditions on the primary end point.
During follow-up, 88 patients (14.7%) had an end point event. Univariate analysis showed that male gender, diabetes, symptomatic peripheral arterial disease, ankle brachial index ≤0.9, SCS, and high IMT were related to the primary end point. Cox regression showed that peripheral arterial disease (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.18-3.59; P=0.011), SCS (HR, 3.02; 95% CI, 1.78-5.13; P=0.0001), and high IMT (HR, 1.86; 95% CI, 1.05-3.29; P=0.032) were related to the primary end point. If patients with scheduled revascularization procedures were excluded from the Cox regression, then ultrasonographic markers were SCS (HR, 1.84; 95% CI, 1.03-3.28; P<0.039) and high IMT (HR, 1.86; 95% CI, 1.06-3.27; P=0.030).
Both SCS and high IMT have an independent impact as markers of major cardiovascular events or death after a first-ever noncardioembolic stroke.
关于颈动脉内膜中层厚度（IMT）对卒中复发的预测价值的数据较少。我们旨在分析与有显著颈动脉狭窄（SCS）的患者相比，IMT 值较高的卒中患者的预后差异。
多中心观察性 ARTICO 研究纳入了 620 例年龄大于 60 岁的首次非心源性卒中患者。患者接受了为期 1 年的随访。主要终点是心血管事件和死亡的复合终点。IMT-ARTICO 子研究分析了 599 例患者的超声数据。在经颅多普勒颈动脉超声检查后，患者被分为 SCS 组（颈动脉狭窄≥50%；117 例）、高 IMT 组（颈总动脉 IMT 处于最高四分位≥1.11mm 且无 SCS；110 例）和对照组（颈总动脉 IMT＜1.11mm 且无 SCS；372 例）。我们分析了这两种情况对主要终点的影响。
在随访期间，88 例患者（14.7%）发生了终点事件。单因素分析显示，男性、糖尿病、有症状的外周动脉疾病、踝肱指数≤0.9、SCS 和高 IMT 与主要终点相关。Cox 回归显示，外周动脉疾病（危险比[HR]，2.06；95%置信区间[CI]，1.18-3.59；P=0.011）、SCS（HR，3.02；95% CI，1.78-5.13；P=0.0001）和高 IMT（HR，1.86；95% CI，1.05-3.29；P=0.032）与主要终点相关。如果将计划进行血管再通手术的患者从 Cox 回归中排除，则超声标志物为 SCS（HR，1.84；95% CI，1.03-3.28；P<0.039）和高 IMT（HR，1.86；95% CI，1.06-3.27；P=0.030）。
在首次非心源性卒中后，SCS 和高 IMT 均作为主要心血管事件或死亡的独立标志物具有重要意义。
