Dixon S, Pais S O, Raviola C, Gomes A, Machleder H I, Baker J D, Busuttil R W, Barker W F, Moore W S
Arch Surg. 1982 Nov;117(11):1493-8. doi: 10.1001/archsurg.1982.01380350079011.
The natural history of 153 asymptomatic, nonstenotic ulcerative lesions of the carotid bifurcation in 141 patients was reviewed. A technique for quantitatively defining small (A), large (B), and compound (C) ulcers was developed. During the course of study, extending up to ten years, 3% of patients with A ulcers, 21% with B ulcers, and 19% with C ulcers had hemispheric strokes without antecedent transient ischemic attacks (TIAs), on the side appropriate to the lesion. The interval annual stroke rate was 4.5% for B ulcers and 7.5% for C ulcers. Because these interval stroke rates are comparable to the 6% annual stroke rate occurring in patients with TIAs, a well-accepted indication for operation, we recommend prophylactic operation for these lesions in good surgical candidates, to be performed by surgeons who have demonstrably low operative stroke rates.
回顾了141例患者153处无症状、无狭窄的颈动脉分叉溃疡性病变的自然病史。开发了一种定量定义小（A）、大（B）和复合（C）溃疡的技术。在长达十年的研究过程中，A组溃疡患者中有3%、B组溃疡患者中有21%、C组溃疡患者中有19%在病变相应侧发生了无前兆短暂性脑缺血发作（TIA）的半球性卒中。B组溃疡的年卒中发生率为4.5%，C组溃疡为7.5%。由于这些期间卒中发生率与TIA患者6%的年卒中发生率相当，而TIA是公认的手术指征，因此我们建议对手术条件良好的这些病变患者进行预防性手术，手术由手术卒中发生率明显较低的外科医生进行。
