Imparato A M, Riles T S, Mintzer R, Baumann F G
Ann Surg. 1983 Feb;197(2):195-203. doi: 10.1097/00000658-198302000-00012.
In a prospective study 376 carotid artery plaques (275 symptomatic, 101 asymptomatic) were obtained from endarterectomies (184 unilateral and 96 bilateral) in 280 patients. The gross morphologic features of each plaque were noted at surgery and, together with the patient's clinical history, stored in computer memory. These data were analyzed in order to investigate the relationship of gross morphologic plaque characteristics with both the presence of cerebral symptoms and the degree of stenosis associated with the plaque. Ulceration was the most frequently observed of the five major gross plaque morphologic characteristics (46.0% of all plaques), but only intramural hemorrhage (30.6% of all plaques) was significantly more common in all symptomatic compared with all asymptomatic plaques (p less than 0.02). Hemorrhage was also the only gross characteristic significantly more common in focal symptomatic plaques when compared with either asymptomatic plaques (p less than 0.05) or nonfocal symptomatic plaques (p less than 0.01). When all the plaques were divided into three broad degrees of stenosis groups (0-39%, 40-69%, 70-99%) on the basis of angiographic data, only hemorrhage showed a significant correlation in incidence with increased degree of plaque stenosis, both when all plaques were considered (p less than 0.001) and when only symptomatic plaques were examined (p less than 0.001). The results indicate that intramural hemorrhage is the only carotid plaque gross morphologic characteristic significantly more frequent in symptomatic compared with asymptomatic plaques and the only characteristic significantly correlated with increased plaque size. These findings indicate that factors other than plaque ulceration and intraluminal thrombus play an important role in carotid plaque related cerebral symptoms. The data also raise questions concerning the unequivocal value of anticoagulant therapy in carotid artery disease, especially in highly stenotic lesions.
在一项前瞻性研究中，从280例患者的动脉内膜切除术（184例单侧和96例双侧）中获取了376个颈动脉斑块（275个有症状，101个无症状）。在手术中记录每个斑块的大体形态特征，并与患者的临床病史一起存储在计算机内存中。对这些数据进行分析，以研究斑块大体形态特征与脑症状的存在以及与斑块相关的狭窄程度之间的关系。溃疡是五种主要斑块大体形态特征中最常观察到的（占所有斑块的46.0%），但与所有无症状斑块相比，只有壁内出血（占所有斑块的30.6%）在所有有症状斑块中明显更常见（p<0.02）。与无症状斑块（p<0.05）或非局灶性有症状斑块（p<0.01）相比，出血也是局灶性有症状斑块中唯一明显更常见的大体特征。根据血管造影数据将所有斑块分为三个广泛的狭窄程度组（0-39%、40-69%、70-99%），无论是考虑所有斑块（p<0.001）还是仅检查有症状斑块（p<0.001）时，只有出血在发病率上与斑块狭窄程度增加呈显著相关。结果表明，壁内出血是与无症状斑块相比在有症状斑块中明显更频繁出现的唯一颈动脉斑块大体形态特征，也是与斑块大小增加显著相关的唯一特征。这些发现表明，除了斑块溃疡和腔内血栓之外的因素在与颈动脉斑块相关的脑症状中起重要作用。这些数据也对颈动脉疾病中抗凝治疗的明确价值提出了疑问，尤其是在高度狭窄病变中。
