Department of Surgery, University of California, San Francisco, East Bay, Oakland (R.C.G., K.A.R.).
Department of Surgery, University of California, San Francisco (E.L.).
Stroke. 2022 Sep;53(9):2838-2846. doi: 10.1161/STROKEAHA.121.038426. Epub 2022 Jun 8.
Moderate carotid artery stenosis is a poorly defined risk factor for ischemic stroke. As such, practice recommendations are lacking. In this study, we describe the long-term risk of stroke in patients with moderate asymptomatic stenosis in an integrated health care system.
All adult patients with asymptomatic moderate (50%-69%) internal carotid artery stenosis between 2008 and 2012 were identified, with follow-up through 2017. The primary outcome was acute ischemic stroke attributed to the ipsilateral carotid artery. Stroke rates were calculated using competing risk analysis. Secondary outcomes included disease progression, ipsilateral intervention, and long-term survival.
Overall, 11 614 arteries with moderate stenosis in 9803 patients were identified. Mean age was 74.2±9.9 years with 51.4% women. Mean follow-up was 5.1±2.9 years. There were 180 ipsilateral ischemic strokes (1.6%) identified (crude annual risk, 0.31% [95% CI, 0.21%-0.41%]), of which thirty-one (17.2%) underwent subsequent intervention. Controlling for death and intervention as competing risks, the cumulative incidence of stroke was 1.2% (95% CI, 1.0%-1.4%) at 5 years and 2.0% (95% CI, 1.7%-2.4%) at 10 years. Of identified strokes, 50 (27.8%) arteries had progressed to severe stenosis or occlusion. During follow-up, there were 17 029 carotid studies performed in 5951 patients, revealing stenosis progression in 1674 (14.4%) arteries, including 1614 (13.9%) progressing to severe stenosis and 60 (0.5%) to occlusion. The mean time to stenosis progression was 2.6±2.1 years. Carotid intervention occurred in 708 arteries (6.1%). Of these, 66.1% (468/708) had progressed to severe stenosis. The overall mortality rate was 44.5%, with 10.5% of patients lost to follow-up.
In this community-based sample of patients with asymptomatic moderate internal carotid artery stenosis followed for an average of 5 years, the cumulative incidence of stroke is low out to 10 years. Future research is needed to optimize management strategies for this population.
中度颈动脉狭窄是缺血性卒中的一个定义不明确的风险因素。因此，缺乏实践建议。在这项研究中，我们描述了在一个综合医疗保健系统中，无症状中度狭窄（50%-69%）患者的长期卒中风险。
在 2008 年至 2012 年间，确定了所有患有无症状中度（50%-69%）颈内动脉狭窄的成年患者，并进行了至 2017 年的随访。主要结局是同侧颈动脉狭窄引起的急性缺血性卒中。使用竞争风险分析计算卒中发生率。次要结局包括疾病进展、同侧干预和长期生存。
总体而言，在 9803 名患者中确定了 11614 条中度狭窄的动脉。平均年龄为 74.2±9.9 岁，女性占 51.4%。平均随访时间为 5.1±2.9 年。共发现 180 例同侧缺血性卒中（1.6%）（粗年发生率为 0.31%[95%CI，0.21%-0.41%]），其中 31 例（17.2%）随后进行了干预。在控制死亡和干预作为竞争风险的情况下，5 年时的累积卒中发生率为 1.2%（95%CI，1.0%-1.4%），10 年时为 2.0%（95%CI，1.7%-2.4%）。在确定的卒中中，50 条（27.8%）动脉进展为严重狭窄或闭塞。在随访期间，在 5951 名患者中进行了 17029 次颈动脉研究，发现 1674 条（14.4%）动脉狭窄进展，其中 1614 条（13.9%）进展为严重狭窄，60 条（0.5%）进展为闭塞。狭窄进展的平均时间为 2.6±2.1 年。进行了 708 次颈动脉介入治疗（6.1%）。其中，66.1%（468/708）进展为严重狭窄。总的死亡率为 44.5%，有 10.5%的患者失访。
在这项基于社区的无症状中度颈内动脉狭窄患者样本中，平均随访 5 年，10 年内累积卒中发生率较低。需要进一步研究以优化该人群的管理策略。
