Morales-Gisbert Sara Mercedes, Plaza-Martínez Ángel, Sala-Almonacil Vicente Andrés, Olmos-Sánchez David, Gomez-Palonés Francisco Julián, Ortiz-Monzón Eduardo
Servicio de Angiología, Cirugía Vascular y Endovascular, Hospital Universitario Doctor Peset, Valencia, España.
Med Clin (Barc). 2013 Apr 20;140(8):337-42. doi: 10.1016/j.medcli.2012.06.031. Epub 2013 Jan 20.
To understand the evolution of moderate asymptomatic carotid stenosis, the factors that influence its progression and the related morbimortality.
Retrospective observational study of 133 patients with asymptomatic carotid stenosis between 50-69% in one or both carotids between 2002 and 2009. Included patients were subjected to screening for peripheral arterial disease (PAD), aneurysmal disease or carotid bruit. The monitoring was carried out using an annual duplex scan. The rate of progression, the variables related to this, the appearance of neurological events, and global and cardiovascular mortality were evaluated. Descriptive studies, univariate analysis (chi-squared test and Student's t-test), multivariate analysis (logistic regression), and survival curves (Log-Rank test) were carried out.
With an average time of monitoring: 30.8 ± 1.7 months, stenosis progression was observed in 33% of the patients, with an average progression time of 31.3 ± 2.7 months. Greater progression was observed in the subgroup of patients with PAD and ischemic heart disease (odds ratio [OR] 2.84, confidence interval [CI] 95% 1.14-7.03). In the multivariate analysis only the PAD was identified as a risk factor for progression (P=.043). The group of patients with progression showed greater rates of neurological events: 15 vs. 1.6% (P=.01), greater global mortality: 15 vs. 3% (P=.04), and greater cardiovascular mortality: 12.1 vs. 1.5% (P=.03).
The progression of asymptomatic carotid stenosis between 50-69% is common in patients subjected to screening, especially in those with a history of ischaemic heart disease and/or PAD. This progression is associated with an increased rate of cardiovascular complications. For this reason, we recommend clinical and echographic follow-up of these patients.
了解中度无症状性颈动脉狭窄的演变、影响其进展的因素以及相关的病死情况。
对2002年至2009年间133例一侧或双侧颈动脉狭窄率在50% - 69%的无症状性颈动脉狭窄患者进行回顾性观察研究。纳入的患者接受了外周动脉疾病（PAD）、动脉瘤疾病或颈动脉杂音的筛查。通过每年一次的双功超声扫描进行监测。评估狭窄进展率、与之相关的变量、神经事件的发生情况以及全因死亡率和心血管死亡率。进行了描述性研究、单因素分析（卡方检验和学生t检验）、多因素分析（逻辑回归）以及生存曲线分析（对数秩检验）。
平均监测时间为30.8 ± 1.7个月，33%的患者出现了狭窄进展，平均进展时间为31.3 ± 2.7个月。在患有PAD和缺血性心脏病的患者亚组中观察到更大程度的进展（优势比[OR] 2.84，95%置信区间[CI] 1.14 - 7.03）。在多因素分析中，仅PAD被确定为进展的危险因素（P = 0.043）。出现进展的患者组神经事件发生率更高：15% 对1.6%（P = 0.01），全因死亡率更高：15% 对3%（P = 0.04），心血管死亡率更高：12.1% 对1.5%（P = 0.03）。
在接受筛查的患者中，50% - 69%的无症状性颈动脉狭窄进展较为常见，尤其是在有缺血性心脏病和/或PAD病史的患者中。这种进展与心血管并发症发生率增加相关。因此，我们建议对这些患者进行临床和超声随访。
