Nicholls S C, Phillips D J, Bergelin R O, Beach K W, Primozich J F, Strandness D E
J Vasc Surg. 1985 May;2(3):375-81. doi: 10.1067/mva.1985.avs0020375.
The results following carotid endarterectomy were prospectively evaluated in 134 patients (145 sides) by repeat ultrasonic duplex scanning and clinical evaluation extending for a period of 4 years. There were 107 men and 27 women in the study group. The perioperative stroke rate was 1.3% and the mortality rate, 0.7%. There were 9 late deaths, of which two were stroke related (1.4%). Focal symptoms occurred in 12 patients on the ipsilateral side, six of which were strokes (one lacunar). The remaining symptoms developed in the presence of moderate degrees of carotid stenosis (less than 50%). There were seven patients who had transient ischemic attacks (TIAs) referable to the operated side, but only two of these were associated with a recurrent high-grade stenosis. During follow-up 32 (22%) patients had recurrent high-grade stenosis. Restenosis regressed in seven, giving a persistent rate of 17.1%. The incidence of restenosis was significantly higher in women (p less than 0.01). By life-table analysis, restenosis occurred early, the majority within 24 months. There was no consistent association between the development of symptoms and the occurrence of restenosis. Therefore, it is concluded that there is no justification for reoperation based on the degree of narrowing observed to prevent subsequent TIAs and strokes.
通过重复超声双功扫描和长达4年的临床评估，对134例患者（145侧）颈动脉内膜切除术后的结果进行了前瞻性评估。研究组中有107名男性和27名女性。围手术期卒中发生率为1.3%，死亡率为0.7%。有9例晚期死亡，其中2例与卒中相关（1.4%）。12例患者同侧出现局灶性症状，其中6例为卒中（1例腔隙性梗死）。其余症状出现在中度颈动脉狭窄（小于50%）的情况下。有7例患者出现与手术侧相关的短暂性脑缺血发作（TIA），但其中只有2例与复发性高度狭窄有关。在随访期间，32例（22%）患者出现复发性高度狭窄。7例患者的再狭窄情况有所改善，持续发生率为17.1%。女性再狭窄发生率明显更高（p<0.01）。通过寿命表分析，再狭窄出现较早，大多数发生在24个月内。症状的出现与再狭窄的发生之间没有一致的关联。因此，得出结论，基于观察到的狭窄程度进行再次手术以预防随后的TIA和卒中是没有道理的。
