Lavenson George S, Andersen Charles A
Department of Surgery, Uniformed Services University, Bethesda, MD, USA.
Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA.
Ann Transl Med. 2021 Jul;9(14):1202. doi: 10.21037/atm-20-7687.
There are approximately 800,000 strokes in the United States (U.S.) annually. This number has remained the same for decades despite efforts at prevention. The Center for Disease Control (CDC) estimates that 80% of strokes could be prevented. A prime reason for failure of prevention is that the three immediate modifiable causes of strokes, carotid artery disease (CAD), atrial fibrillation (AFib), and hypertension (HTN) are asymptomatic in 80% of cases prior to the stroke. Strokes occur predominantly in seniors and the only possible means of reducing strokes on a large scale is to screen seniors for the asymptomatic disease so that it can be preemptively managed. We present a quick, accurate and cost-effective method of screening the senior population for asymptomatic carotid disease. The technique is a quick carotid scan (QCS). The QCS is a 1-minute long, image only, rapid, color flow ultrasound scan of the cervical carotid arteries that had a sensitivity of 97% when evaluated at New York University (NYU). Once identified by the QCS the approximately 8% of those screened found to have a positive QCS can then be referred for a full carotid duplex ultrasound (DUS). Those patients with a positive DUS can then be referred for further evaluation and appropriate stroke prevention management. The use of a full carotid DUS for screening widely for carotid disease is too time consuming and too costly. Approximately 160,000 or nearly 20% of the 800,000 strokes that occur annually in the U.S. are due to CAD that could in large part be prevented by screening the senior population with the QCS, finding those with CAD, evaluating them, and preemptively managing them prior to the occurrence of the stroke.
在美国，每年约有80万例中风病例。尽管在预防方面做出了努力，但这一数字几十年来一直保持不变。疾病控制中心（CDC）估计，80%的中风是可以预防的。预防失败的一个主要原因是，中风的三个直接可改变病因，即颈动脉疾病（CAD）、心房颤动（AFib）和高血压（HTN），在中风发生前80%的病例中是无症状的。中风主要发生在老年人中，大规模减少中风的唯一可能方法是对老年人进行无症状疾病筛查，以便能够进行预防性管理。我们提出了一种快速、准确且经济高效的方法，用于筛查老年人群中的无症状颈动脉疾病。该技术是快速颈动脉扫描（QCS）。QCS是对颈部颈动脉进行的仅1分钟的图像、快速、彩色血流超声扫描，在纽约大学（NYU）评估时其灵敏度为97%。一旦通过QCS识别出，在筛查人群中约8%的QCS呈阳性者可被转诊进行全面的颈动脉双功超声（DUS）检查。那些DUS呈阳性的患者随后可被转诊进行进一步评估和适当的中风预防管理。使用全面的颈动脉DUS广泛筛查颈动脉疾病既耗时又昂贵。在美国每年发生的80万例中风中，约16万例（近20%）是由CAD引起的，通过用QCS筛查老年人群、发现患有CAD的人、对他们进行评估并在中风发生前进行预防性管理，在很大程度上可以预防这些中风。
