Langsfeld M, Gray-Weale A C, Lusby R J
Department of Surgery, University of Sydney, Repartriation General Hospital, New South Wales, Australia.
J Vasc Surg. 1989 Apr;9(4):548-57. doi: 10.1067/mva.1989.vs0090548.
To determine the natural history of changes in plaque morphology and luminal diameter of atherosclerotic carotid arteries, we used duplex scanning to follow-up (1) the contralateral artery in 289 patients who had undergone carotid endarterectomy, with a mean follow-up 22 months and a range of 0 to 48 months and (2) the carotid arteries in 130 patients who had no surgical treatment and had been symptom free, with a mean follow-up period of 15 months and a range of 0 to 48 months. Plaques were graded as to the ratio of echolucency to echogenicity, with type 1 being most echolucent and type 4 being most echogenic. A normal-appearing artery was classified as type 5. Heterogeneous plaques (types 1 and 2) occurred significantly more (p less than 0.001) in symptomatic preoperative arteries than in asympatomatic arteries. Follow-up of the asymptomatic vessels showed that the majority of plaques either remained the same or became more echogenic (fibrous). Approximately one fourth of plaques in each group degenerated (more echolucent). Thirty-one patients (10.7%) developed new symptoms in the contralateral asymptomatic group, with 10 patients (3.5%) having strokes. Fourteen of 130 (10.8%) patients, or 5.4% of vessel territories at risk, in the primary asymptomatic group developed new symptoms, with only two strokes occurring. In the contralateral asymptomatic group those patients who initially had greater than 75% stenoses fared worse than those with primary asymptomatic disease with greater than 75% stenosis. Although the overall development of new symptoms is low in both populations, our data indicate that those patients with heterogeneous plaques or whose plaques have undergone change may be at risk for new symptoms. Longer follow-up studies are needed to define the role of plaque changes in the development of symptoms. For now we advocate a conservative "wait and see" approach to symptom-free patients with greater than 75% stenoses and calcified plaques. We suggest a more aggressive approach, recommending early surgical intervention, to those few patients with heterogeneous plaques.
为了确定动脉粥样硬化性颈动脉斑块形态和管腔直径变化的自然病程，我们采用双功扫描对以下两组患者进行随访：（1）289例接受颈动脉内膜切除术患者的对侧动脉，平均随访22个月，范围为0至48个月；（2）130例未接受手术治疗且无症状的患者的颈动脉，平均随访期为15个月，范围为0至48个月。根据回声透亮度与回声强度的比值对斑块进行分级，1型为最透声，4型为最回声强。外观正常的动脉归类为5型。术前有症状的动脉中异质性斑块（1型和2型）的发生率显著高于无症状动脉（p小于0.001）。对无症状血管的随访显示，大多数斑块要么保持不变，要么变得回声更强（纤维化）。每组中约四分之一的斑块发生退变（更透声）。对侧无症状组中有31例患者（10.7%）出现新症状，其中10例患者（3.5%）发生中风。在原发性无症状组中，130例患者中有14例（10.8%），即有风险血管区域的5.4%出现新症状，仅发生2例中风。在对侧无症状组中，最初狭窄程度大于75%的患者预后比原发性无症状疾病且狭窄程度大于75%的患者更差。尽管两组患者中新症状的总体发生率都较低，但我们的数据表明，那些有异质性斑块或斑块发生变化的患者可能有出现新症状的风险。需要更长时间的随访研究来确定斑块变化在症状发生中的作用。目前，我们主张对狭窄程度大于75%且有钙化斑块的无症状患者采取保守的“观察等待”方法。对于少数有异质性斑块的患者，我们建议采取更积极的方法，即推荐早期手术干预。
