Paraskevas Kosmas I, Nicolaides Andrew N, Kakkos Stavros K
Department of Surgery, Central Clinic of Athens, Athens, Greece.
Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus.
Ann Transl Med. 2020 Oct;8(19):1271. doi: 10.21037/atm.2020.02.156.
The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study is the largest natural history study on patients with 50-99% asymptomatic carotid stenosis (ACS). It included 1,121 ACS individuals with a follow-up between 6 and 96 months (mean: 48 months). During the last 15 years, several important ACSRS substudies have been published that have contributed significantly to the optimal management of ACS patients. These studies have demonstrated that specific baseline clinical characteristics and ultrasonic plaque features after image normalization (namely carotid plaque type, gray scale median, carotid plaque area, juxtaluminal black area without a visible echogenic cup, discrete white areas in an echolucent part of a plaque, silent embolic infarcts on brain computed tomography scans, a history of contralateral transient ischemic attacks/strokes) can independently predict future ipsilateral cerebrovascular events. The ACSRS study provided proof that by use of a computer program to normalize plaque images and extract plaque texture features, a combination of features can stratify patients into various categories depending on their stroke risk. The present review will discuss the various reported predictors of future ipsilateral cerebrovascular events and how these characteristics can be used to calculate individual stroke risk.
无症状性颈动脉狭窄与卒中风险（ACSRS）研究是针对50%-99%无症状性颈动脉狭窄（ACS）患者开展的规模最大的自然史研究。该研究纳入了1121例ACS患者，随访时间为6至96个月（平均48个月）。在过去15年中，发表了几项重要的ACSRS子研究，这些研究对ACS患者的优化管理做出了重大贡献。这些研究表明，特定的基线临床特征和图像标准化后的超声斑块特征（即颈动脉斑块类型、灰度中位数、颈动脉斑块面积、无可见回声环的管腔旁黑色区域、斑块无回声部分的离散白色区域、脑部计算机断层扫描上的无症状栓塞性梗死、对侧短暂性脑缺血发作/卒中病史）能够独立预测未来同侧脑血管事件。ACSRS研究证明，通过使用计算机程序对斑块图像进行标准化并提取斑块纹理特征，根据患者的卒中风险，多种特征组合可将患者分为不同类别。本综述将讨论各种已报道的未来同侧脑血管事件预测因素，以及如何利用这些特征来计算个体卒中风险。
