Schroeder T, Helgstrand U J, Egeblad M R, Engell H C
Arch Surg. 1987 Jul;122(7):795-801. doi: 10.1001/archsurg.1987.01400190061012.
Of 185 patients who consecutively underwent carotid endarterectomy five years ago, 135 had a patent asymptomatic contralateral internal carotid artery (ICA). During follow-up (median, 59 months), 36 patients developed new neurologic symptoms (18 strokes and 18 transient ischemic attacks). Thirteen patients developed symptoms referable to the territory of the previously asymptomatic ICA (five strokes and eight transient ischemic attacks). Using life-table analysis, the annual stroke rate was estimated to be 1% and 2.2% considering the previously asymptomatic and symptomatic ICA, respectively. Separating patients according to the degree of stenosis on the preoperative angiogram and according to the presence of ulceration revealed a significantly higher incidence of neurologic events and strokes in patients with stenoses exceeding 50% and/or patients with obvious ulcerations. Although the risk of stroke without warning was increased in these subgroups, we did not consider the risk high enough to warrant prophylactic endarterectomy. An exception enough to warrant prophylactic endarterectomy. An exception may be the patient with a more than 90% stenosis.
在五年前连续接受颈动脉内膜切除术的185例患者中，135例对侧颈内动脉（ICA）通畅且无症状。在随访期间（中位数为59个月），36例患者出现了新的神经系统症状（18例中风和18例短暂性脑缺血发作）。13例患者出现了与之前无症状的ICA供血区域相关的症状（5例中风和8例短暂性脑缺血发作）。采用寿命表分析，考虑到之前无症状和有症状的ICA，年中风率分别估计为1%和2.2%。根据术前血管造影的狭窄程度以及溃疡的存在情况对患者进行分类，结果显示狭窄超过50%的患者和/或有明显溃疡的患者发生神经系统事件和中风的发生率显著更高。尽管在这些亚组中无预警中风的风险增加，但我们认为该风险不足以高到需要进行预防性内膜切除术。一个足以需要进行预防性内膜切除术的例外情况可能是狭窄超过90%的患者。
