Division of Surgery and Interventional Science, University College London, London, UK.
Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.
Br J Surg. 2019 Jun;106(7):872-878. doi: 10.1002/bjs.11136. Epub 2019 Apr 2.
Carotid stenosis is a common cause of ischaemic stroke and transient ischaemic attack (TIA). Despite rising recognition and centralization of stroke services there has been a decline in interventions for carotid stenosis in recent years. The aim of this study was to determine the current prevalence and management of carotid stenosis in the UK.
This was a 1-year prospective observational study of consecutive patients presenting with ischaemic stroke, TIA or ischaemic retinal artery occlusion to a central London hyperacute stroke unit. Patients with significant carotid stenosis, defined as atherosclerotic narrowing of 50 per cent or greater, underwent multidisciplinary team (MDT) discussion to determine the cause of stroke/TIA and classify carotid stenosis as symptomatic or incidental.
In total, 2707 patients were seen; half had an ischaemic event and the majority had carotid imaging (1252 of 1444). Carotid stenosis of at least 50 per cent was seen in 238 (prevalence 19·0 (95 per cent c.i. 16·6 to 21·4) per cent). Patients with significant carotid stenosis were more likely to have hypertension, hypercholesterolaemia, diabetes and ischaemic heart disease. Carotid stenosis was deemed symptomatic in 99 patients (7·9 (6·3 to 9·5) per cent); of these, 17 had carotid occlusion, 17 were unfit for surgery and 58 patients were referred for carotid intervention. Among 139 patients with asymptomatic stenosis, 75 had carotid stenosis ipsilateral to the stroke but, after MDT discussion, the cause was deemed to be atrial fibrillation (32), small-vessel disease (15), another determined cause (5), or not determined owing to atypical imaging or clinical presentation.
Carotid stenosis is common, affecting one in five patients presenting with stroke or TIA. Careful MDT discussion may avoid unnecessary intervention and should be the standard of care.
颈动脉狭窄是缺血性卒中和短暂性脑缺血发作（TIA）的常见原因。尽管对中风服务的认识和集中程度不断提高，但近年来颈动脉狭窄的干预措施却有所减少。本研究旨在确定英国目前颈动脉狭窄的患病率和治疗方法。
这是一项为期 1 年的前瞻性观察性研究，连续纳入到伦敦市中心超急性中风病房就诊的缺血性中风、TIA 或缺血性视网膜动脉闭塞患者。有明显颈动脉狭窄（定义为动脉粥样硬化狭窄 50%或以上）的患者接受多学科团队（MDT）讨论，以确定中风/TIA 的病因，并将颈动脉狭窄归类为症状性或偶发性。
共观察到 2707 例患者；其中一半有缺血性事件，大多数患者进行了颈动脉成像（1444 例中有 1252 例）。至少有 50%的颈动脉狭窄的患者有 238 例（患病率为 19.0%（95%置信区间 16.6%至 21.4%））。有明显颈动脉狭窄的患者更可能患有高血压、高胆固醇血症、糖尿病和缺血性心脏病。99 例（7.9%（6.3%至 9.5%））颈动脉狭窄被认为是症状性的；其中 17 例有颈动脉闭塞，17 例不适合手术，58 例患者被转介进行颈动脉介入治疗。在 139 例无症状性狭窄患者中，75 例同侧颈动脉狭窄，但在 MDT 讨论后，病因被认为是房颤（32 例）、小血管疾病（15 例）、另一个确定的病因（5 例）或由于不典型的影像学或临床表现而无法确定病因。
颈动脉狭窄很常见，每 5 例中风或 TIA 患者中就有 1 例患有颈动脉狭窄。仔细的 MDT 讨论可能避免不必要的干预，应成为标准的治疗方法。
