Fritz V U, Levien L J
Department of Neurology, Johannesburg Hospital, South Africa.
Ann Vasc Surg. 1988 Oct;2(4):367-72. doi: 10.1016/S0890-5096(06)60818-2.
This study evaluates whether medical therapy alone can achieve satisfactory results in the treatment of low grade carotid stenosis or ulcerated plaques. Out of 525 patients presenting with transient or minor strokes, 64 were found with unilateral extracranial vascular disease as the sole potential source for their neurological symptoms. Utilizing arteriographic criteria, 35 patients with ulcerated plaques or carotid artery stenosis of less than 50% luminal artery diameter were treated conservatively with aspirin and dipyridamole (300 mg/day each). Twenty-nine patients with unilateral internal carotid artery stenosis of greater than 50% luminal artery diameter were treated by means of carotid endarterectomy. Follow-up in the two groups for a mean period of 24-26 months revealed no major strokes or neurological deaths in either group. Myocardial infarction was the major cause of death. Two patients developed subsequent transient ischemic attacks, and one a minor stroke with total recovery in the conservatively treated group. All became asymptomatic when warfarin replaced aspirin therapy. The findings in this study confirmed that "low grade" stenoses can be safely treated by medical measures alone.
本研究评估单纯药物治疗能否在治疗低度颈动脉狭窄或溃疡性斑块方面取得满意效果。在525例出现短暂性或轻度中风的患者中，发现64例患有单侧颅外血管疾病，这是其神经症状的唯一潜在病因。根据血管造影标准，35例患有溃疡性斑块或颈动脉狭窄且管腔动脉直径小于50%的患者采用阿司匹林和双嘧达莫（各300毫克/天）进行保守治疗。29例单侧颈内动脉狭窄且管腔动脉直径大于50%的患者接受了颈动脉内膜切除术。两组平均随访24 - 26个月，结果显示两组均未发生严重中风或神经源性死亡。心肌梗死是主要死因。在保守治疗组中，有2例随后发生短暂性脑缺血发作，1例发生轻度中风但完全康复。当华法林取代阿司匹林治疗后，所有患者均无症状。本研究结果证实，“低度”狭窄仅通过药物治疗即可安全有效。
