Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
Acta Neurol Scand. 2018 May;137(5):462-468. doi: 10.1111/ane.12886. Epub 2017 Dec 18.
Carotid artery stenosis is one of the major causes of transient ischemic attack (TIA) and acute ischemic stroke (IS), and carotid surgery and stenting are used to reduce the risk of ipsilateral IS. However, the adherence to the recommendation of carotid imaging in clinical practice has not been well studied. We analyzed proportions of carotid imaging and determinants for its non-use in patients with TIA and IS with respect to baseline demographics, risk factors, hospital characteristics, and geographical region.
Hospital-based data on TIA and IS events, registered from July 2011 to June 2013, were obtained from the Swedish Stroke Register (Riksstroke). Carotid imaging diagnostics included carotid Doppler ultrasound and computed tomography angiography.
Carotid imaging was performed in 70% (10 545/15 021) of patients with TIA and 54% (23 772/44 075) of patients with IS. The most significant independent determinants for not undergoing carotid imaging were, in patients with TIA: age ≥85 year (odds ratio (OR), 7.3; 95% confidence interval (CI), 6.4-8.4) and a history of stroke (OR, 2.3; 95% CI, 2.1-2.5); and in patients with IS: age ≥85 year (OR, 9.8; 95% CI, 9.0-10.6), age 75-84 year (OR, 2.5; 95% CI, 2.3-2.7), and reduced level of consciousness at admission (OR, 3.4; 95% CI, 3.1-3.6). Care at a University hospital and in a stroke unit increased the likelihood of carotid imaging. There were substantial regional variations regarding proportions of carotid imaging.
Carotid imaging appears to be underused in patients with TIA and IS. Opportunities of secondary stroke prevention with carotid interventions are likely missed.
颈动脉狭窄是短暂性脑缺血发作（TIA）和急性缺血性脑卒中（IS）的主要原因之一，颈动脉手术和支架置入术用于降低同侧 IS 的风险。然而，临床实践中对颈动脉影像学检查的推荐的遵循情况尚未得到很好的研究。我们分析了 TIA 和 IS 患者中颈动脉影像学检查的比例及其不使用的决定因素，涉及基线人口统计学、危险因素、医院特征和地理位置。
2011 年 7 月至 2013 年 6 月，从瑞典卒中登记处（Riksstroke）获得了 TIA 和 IS 事件的基于医院的数据。颈动脉影像学诊断包括颈动脉多普勒超声和计算机断层血管造影。
70%（10 545/15 021）的 TIA 患者和 54%（23 772/44 075）的 IS 患者进行了颈动脉成像。TIA 患者未进行颈动脉成像的最显著独立决定因素是：年龄≥85 岁（优势比（OR），7.3；95%置信区间（CI），6.4-8.4）和卒中史（OR，2.3；95%CI，2.1-2.5）；IS 患者未进行颈动脉成像的最显著独立决定因素是：年龄≥85 岁（OR，9.8；95%CI，9.0-10.6）、年龄 75-84 岁（OR，2.5；95%CI，2.3-2.7）和入院时意识水平降低（OR，3.4；95%CI，3.1-3.6）。在大学医院和卒中病房接受治疗增加了进行颈动脉成像的可能性。在颈动脉成像的比例方面存在很大的地区差异。
TIA 和 IS 患者中颈动脉成像的应用似乎不足。可能错过了通过颈动脉介入进行二级卒中预防的机会。
