Guse F, Weiller C, Brückmann H, Ringelstein E B
Abteilung Neurologie, RWTH Aachen.
Nervenarzt. 1987 Nov;58(11):677-84.
This retrospective study was performed in order to evaluate the relationship between the risk of brain infarction and the severity of 274 internal carotid artery (ICA) stenoses in 218 patients. Clinical, vascular and brain-morphological findings were compared. Of 106 occluded ICAs, 59% had induced a completed stroke with visible hemispheric infarction in 77%, most of them of the territorial type (35%). 32% of 85 high-grade stenoses had led to completed strokes, with territorial, low-flow and microangiopathic patterns of infarction occurring equally frequent. CT was normal in two-thirds of 83 low-grade ICA-stenoses, whereas 14% showed microangiopathic brain lesions. We conclude that (1) asymptomatic ICA stenoses should not be operated on, as long as they are not of very high degree and (2) even symptomatic ICA stenoses should not undergo endarterectomy, if the patient's stroke was due to lacunar infarctions of typical site and size.
本回顾性研究旨在评估218例患者中274处颈内动脉（ICA）狭窄的严重程度与脑梗死风险之间的关系。对临床、血管及脑形态学检查结果进行了比较。在106处闭塞的颈内动脉中，59%导致了完全性卒中，77%可见半球梗死，其中大多数为区域型（35%）。85处高度狭窄中32%导致了完全性卒中，区域型、低灌注型和微血管病变型梗死的发生频率相同。83处低度颈内动脉狭窄中，三分之二的患者CT检查正常，而14%显示有微血管病变性脑损害。我们得出结论：（1）无症状的颈内动脉狭窄，只要程度不是非常严重，就不应进行手术；（2）如果患者的卒中是由典型部位和大小的腔隙性梗死所致，即使是有症状的颈内动脉狭窄也不应接受内膜切除术。
