Hertzer N R, Flanagan R A, Beven E G, O'Hara P J
Ann Surg. 1986 Aug;204(2):163-71. doi: 10.1097/00000658-198608000-00010.
From 1980 through 1982, intravenous extracranial digital subtraction angiography (DSA) was performed in 6684 patients at the Cleveland Clinic. Of these, 290 previously unoperated patients had asymptomatic carotid stenosis exceeding 50% of lumen diameter on unequivocal DSA studies. Either the presence or the absence of carotid bruits substantially misrepresented the severity of angiographic stenosis on approximately 30% of sides. Nonoperative management was employed in 195 patients, including 104 (53%) who received antiplatelet therapy, while another group of 95 patients underwent prophylactic carotid endarterectomy. During mean follow-up intervals of 33-38 months, surgical treatment significantly reduced the cumulative incidence of subsequent neurologic events in men (p = 0.05). Statistically unconfirmed trends also suggested that carotid endarterectomy tended to prevent late strokes in subsets of patients with greater than 70% stenosis or bilateral carotid lesions. The overall stroke rate for women was higher in the surgical group (p = 0.03), in part because of their unusual risk for perioperative complications (9%) in this particular series.
1980年至1982年期间，克利夫兰诊所对6684例患者进行了静脉颅内数字减影血管造影（DSA）检查。其中，290例既往未接受手术的患者在明确的DSA检查中显示无症状性颈动脉狭窄超过管腔直径的50%。在大约30%的病例中，有无颈动脉杂音在很大程度上都不能准确反映血管造影显示的狭窄严重程度。195例患者采用非手术治疗，其中104例（53%）接受了抗血小板治疗，另一组95例患者接受了预防性颈动脉内膜切除术。在平均33 - 38个月的随访期间，手术治疗显著降低了男性随后发生神经系统事件的累积发生率（p = 0.05）。统计学上未经证实的趋势还表明，颈动脉内膜切除术倾向于预防狭窄程度大于70%或双侧颈动脉病变患者亚组中的晚期中风。手术组女性的总体中风发生率较高（p = 0.03），部分原因是在这个特定系列中，她们围手术期并发症的风险异常高（9%）。
