Wechsler L R, Kistler J P, Davis K R, Kaminski M J
Stroke. 1986 Jul-Aug;17(4):714-8. doi: 10.1161/01.str.17.4.714.
We retrospectively reviewed the clinical course and angiograms of 15 patients with carotid siphon stenosis of 50% or greater. Fourteen had less than 50% stenosis at the origin of the ipsilateral internal carotid artery, and one had a greater degree of stenosis but underwent endarterectomy after an initial angiogram. Angiograms were examined for evidence of hemodynamic abnormalities in addition to residual lumen diameter. Seven patients initially had TIAs, 5 had strokes, and 3 were asymptomatic. In an average followup of 51 months (range 4-123 months) subsequent cerebral ischemic events occurred in 6 (40%), but only 1 had a stroke with a persisting neurological deficit that could be directly attributed to the siphon stenosis. Stenoses were hemodynamically significant by angiography in 5 of 7 TIA patients, and only 1 of 5 stroke patients. The incidence of subsequent ischemic events in this study was similar to 2 previous studies of siphon stenosis, however in this study most of the events ipsilateral to the siphon stenosis were TIAs or minor strokes. The association of hemodynamic angiographic abnormalities and initial TIAs but not strokes suggests that the mechanism producing ischemic symptoms may differ in patients with TIA and stroke who have carotid siphon stenosis.
我们回顾性分析了15例颈动脉虹吸部狭窄达50%或更高的患者的临床病程及血管造影结果。其中14例患者同侧颈内动脉起始部狭窄小于50%，1例患者狭窄程度更高，但在初次血管造影后接受了内膜切除术。除了残余管腔直径外，还对血管造影进行了血流动力学异常证据的检查。7例患者最初有短暂性脑缺血发作（TIA），5例发生了中风，3例无症状。平均随访51个月（范围4 - 123个月），6例（40%）随后发生了脑缺血事件，但只有1例中风患者遗留有可直接归因于虹吸部狭窄的持续性神经功能缺损。在7例TIA患者中，5例经血管造影显示狭窄具有血流动力学意义，而在5例中风患者中只有1例如此。本研究中随后缺血事件的发生率与之前两项关于虹吸部狭窄的研究相似，然而在本研究中，大多数与虹吸部狭窄同侧的事件为TIA或轻度中风。血流动力学血管造影异常与初始TIA相关，但与中风无关，这表明在患有颈动脉虹吸部狭窄的TIA和中风患者中，产生缺血症状的机制可能不同。
