无症状性重度颈动脉狭窄患者未行手术干预时的缺血性脑卒中发生率。
Incidence of Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention.
机构信息
Department of Vascular Surgery, The Permanente Medical Group, South San Francisco, California.
Division of Research, Kaiser Permanente Northern California, Oakland.
出版信息
JAMA. 2022 May 24;327(20):1974-1982. doi: 10.1001/jama.2022.4835.
IMPORTANCE
Optimal management of patients with asymptomatic severe carotid stenosis is uncertain, due to advances in medical care and a lack of contemporary data comparing medical and surgical treatment.
OBJECTIVE
To estimate stroke outcomes among patients with medically treated asymptomatic severe carotid stenosis who did not undergo surgical intervention.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study that included 3737 adult participants with asymptomatic severe (70%-99%) carotid stenosis diagnosed between 2008 and 2012 and no prior intervention or ipsilateral neurologic event in the prior 6 months. Participants received follow-up through 2019, and all were members of an integrated US regional health system serving 4.5 million members.
EXPOSURES
Imaging diagnosis of asymptomatic carotid stenosis of 70% to 99%.
MAIN OUTCOMES AND MEASURES
Occurrence of ipsilateral carotid-related acute ischemic stroke. Censoring occurred with death, disenrollment, or ipsilateral intervention.
RESULTS
Among 94 822 patients with qualifying imaging studies, 4230 arteries in 3737 (mean age, 73.8 [SD 9.5 years]; 57.4% male) patients met selection criteria including 2539 arteries in 2314 patients who never received intervention. The mean follow-up in this cohort was 4.1 years (SD 3.6 years). Prior to any intervention, there were 133 ipsilateral strokes with a mean annual stroke rate of 0.9% (95% confidence interval [CI], 0.7%-1.2%). The Kaplan-Meier estimate of ipsilateral stroke by 5 years was 4.7% (95% CI, 3.9%-5.7%).
CONCLUSIONS AND RELEVANCE
In a community-based cohort of patients with asymptomatic severe carotid stenosis who did not undergo surgical intervention, the estimated rate of ipsilateral carotid-related acute ischemic stroke was 4.7% over 5 years. These findings may inform decision-making regarding surgical and medical treatment for patients with asymptomatic severe carotid artery stenosis.
重要性
由于医疗水平的提高和缺乏比较医学治疗与手术治疗的当代数据，无症状严重颈动脉狭窄患者的最佳治疗方法仍不确定。
目的
评估未接受手术干预的接受药物治疗的无症状严重颈动脉狭窄患者的卒中结局。
设计、环境和参与者：这是一项回顾性队列研究，纳入了 2008 年至 2012 年间诊断为无症状严重（70%-99%）颈动脉狭窄的 3737 名成年患者，且在过去 6 个月内没有进行过手术干预或同侧神经事件。参与者接受了 2019 年的随访，他们均为一个服务 450 万成员的美国综合性区域健康系统的成员。
暴露因素
无症状颈动脉狭窄 70%至 99%的影像学诊断。
主要结果和测量指标
同侧颈动脉相关急性缺血性卒中的发生。以死亡、退出或同侧干预为终点进行删失。
结果
在 94822 名有合格影像学研究的患者中，3737 名患者（平均年龄 73.8[9.5 岁]；57.4%为男性）的 4230 条动脉符合入选标准，其中 2314 名患者的 2539 条动脉从未接受过干预。该队列的平均随访时间为 4.1 年（3.6 年）。在任何干预之前，同侧发生了 133 次卒中，年卒中发生率平均为 0.9%（95%置信区间[CI]，0.7%-1.2%）。Kaplan-Meier 估计的 5 年同侧卒中发生率为 4.7%（95%CI，3.9%-5.7%）。
结论和相关性
在一项未接受手术干预的无症状严重颈动脉狭窄患者的基于社区的队列研究中，5 年内同侧颈动脉相关急性缺血性卒中的估计发生率为 4.7%。这些发现可能为无症状严重颈动脉狭窄患者的手术和药物治疗决策提供信息。
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