Karlsson L, Kangefjärd E, Hermansson S, Strömberg S, Österberg K, Nordanstig A, Ryndel M, Gellerman K, Fredén-Lindqvist J, Bergström G M L
The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Eur J Vasc Endovasc Surg. 2016 Sep;52(3):287-94. doi: 10.1016/j.ejvs.2016.05.014. Epub 2016 Jun 28.
The objective of this study was to evaluate the risk of recurrent ischaemic stroke in patients with ultrasound assessed symptomatic mild carotid artery stenosis (20-49% NASCET) treated solely with modern medical treatment.
This was a retrospective, observational register cohort study. Three groups of patients were recruited from a database of all carotid Doppler ultrasound examinations performed in the Gothenburg region between 2004 and 2009. Patients with symptomatic mild carotid artery stenosis (n = 162) were compared with patients with asymptomatic carotid artery stenosis (n = 301) of equal degree and a group of patients with surgically (CEA) treated symptomatic moderate or severe carotid artery stenosis (n = 220). Kaplan-Meier estimates and Cox proportional hazard models were used to compare the primary outcome (ipsilateral ischaemic stroke) between groups.
After a 3 year follow up, the cumulative incidence of recurrent ipsilateral stroke in patients with symptomatic mild carotid artery stenosis was 7.4%. Patients with symptomatic mild carotid artery stenosis had a substantially increased risk of recurrent ipsilateral stroke compared with asymptomatic patients with equal degree of stenosis (HR 5.5. 95% CI 1.8-17.1; p = .003) as also compared with patients with CEA treated symptomatic moderate or severe stenosis (HR 7.8. 95% CI 1.62-37.8; p = .011).
The present study on patients with symptomatic mild carotid artery stenosis, as determined by Doppler ultrasound, shows that there is still a substantial risk of recurrent stroke in this group.
本研究旨在评估仅接受现代药物治疗的、经超声评估为有症状的轻度颈动脉狭窄（北美症状性颈动脉内膜切除术协作研究定义为20 - 49%）患者复发性缺血性卒中的风险。
这是一项回顾性观察登记队列研究。从2004年至2009年在哥德堡地区进行的所有颈动脉多普勒超声检查数据库中招募了三组患者。将有症状的轻度颈动脉狭窄患者（n = 162）与同等程度无症状颈动脉狭窄患者（n = 301）以及一组接受手术（颈动脉内膜切除术）治疗的有症状的中度或重度颈动脉狭窄患者（n = 220）进行比较。采用Kaplan - Meier估计法和Cox比例风险模型比较组间的主要结局（同侧缺血性卒中）。
经过3年随访，有症状的轻度颈动脉狭窄患者同侧复发性卒中的累积发生率为7.4%。与同等程度狭窄的无症状患者相比，有症状的轻度颈动脉狭窄患者同侧复发性卒中的风险显著增加（风险比5.5，95%置信区间1.8 - 17.1；p = 0.003），与接受颈动脉内膜切除术治疗的有症状的中度或重度狭窄患者相比也是如此（风险比7.8，95%置信区间1.62 - 37.8；p = 0.011）。
本项针对经多普勒超声确定为有症状的轻度颈动脉狭窄患者的研究表明，该组患者仍存在较高的复发性卒中风险。
