Janko Matthew, Moore Ryan, Kim Ann H, Shevitz Andrew J, Morrow Katherine L, Johnson David J, Kashyap Vikram S
Division of Vascular Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio.
J Vasc Surg. 2017 Nov;66(5):1445-1449. doi: 10.1016/j.jvs.2017.04.041. Epub 2017 Jun 16.
Asymptomatic internal carotid artery occlusion (CO) presents a clinical dilemma, and presently, the natural history, stroke risk, and optimal management remain ill defined. This study compared outcomes, including neurovascular events (NVEs) and health care costs, between patients with CO and patients with asymptomatic carotid artery stenosis (CS).
A prospectively maintained database was queried to identify patients with CO and CS with at least >50% carotid stenosis by duplex. We identified and reviewed 622 consecutive patients with asymptomatic carotid artery disease at one academic medical center between 2011 and 2013. Patients with CO (n = 97) were identified and propensity matched by age and gender in a 1:2 ratio with CS patients (n = 194) for further analyses. Univariate and multivariate models were used to analyze baseline characteristics, clinical variables, and 1-year follow-up data from the date of diagnosis. Multivariate analysis was performed by multiple linear regression modeling. Institutional Review Board approval was obtained.
Follow-up data were available for 99% of matched patients. CO patients were younger (72 vs 75 years; P < .01) and more likely male (67% vs 53%; P = .01) compared with CS patients. After propensity matching, baseline characteristics were similar between groups, with a trend toward higher use of statin therapy among patients with CO. Antiplatelet therapy was used in 79% of patients with CS and in 74% of patients with CO (P = .45). The rate of NVE among CO patients was higher than among CS patients at 1 year of follow-up (14% vs 7%; P = .03). Among those with NVE, neither antiplatelet therapy (64% vs 77%; P = .49) nor statin therapy (86% vs 77%; P = .58) appeared to have a significant effect. Health care costs ($14,361 vs $12,142; P = .44) and hospital admission rate (63% vs 71%; P = .18) were similar between groups. Not surprisingly, the rate of vascular procedures was higher in the CS group (55% vs 27%; P = .04).
Patients with asymptomatic CO experience more NVEs compared with similar patients with moderately severe CS. Further study of preventative strategies, including intensity of medical therapy, is warranted.
无症状性颈内动脉闭塞（CO）带来了临床治疗难题，目前其自然病程、卒中风险及最佳治疗方案仍不明确。本研究比较了CO患者与无症状性颈动脉狭窄（CS）患者的预后，包括神经血管事件（NVE）及医疗费用。
查询前瞻性维护的数据库，以识别经双功超声检查显示颈动脉狭窄至少>50%的CO和CS患者。我们在2011年至2013年期间在一家学术医疗中心识别并回顾了622例连续的无症状性颈动脉疾病患者。识别出CO患者（n = 97），并按年龄和性别以1:2的比例与CS患者（n = 194）进行倾向匹配，以进行进一步分析。使用单变量和多变量模型分析诊断日期起的基线特征、临床变量及1年随访数据。通过多元线性回归建模进行多变量分析。获得了机构审查委员会的批准。
99%的匹配患者有随访数据。与CS患者相比，CO患者更年轻（72岁对75岁；P <.01），男性比例更高（67%对53%；P =.01）。倾向匹配后，两组间基线特征相似，CO患者他汀类药物治疗使用率有更高的趋势。79%的CS患者和74%的CO患者使用了抗血小板治疗（P =.45）。随访1年时，CO患者的NVE发生率高于CS患者（14%对7%；P =.03）。在发生NVE的患者中，抗血小板治疗（64%对77%；P =.49）和他汀类药物治疗（86%对77%；P =.58）似乎均无显著效果。两组间医疗费用（14,361美元对12,142美元；P =.44）和住院率（63%对71%；P =.18）相似。不出所料，CS组的血管手术率更高（55%对27%；P =.04）。
与中度严重CS的类似患者相比，无症状性CO患者发生更多的NVE。有必要对包括药物治疗强度在内的预防策略进行进一步研究。
