Humphrey P R, Marshall J
Stroke. 1981 Nov-Dec;12(6):765-9. doi: 10.1161/01.str.12.6.765.
This study analyzes 234 patients who recovered from an initial ischemic episode. The object was to see if the duration of the first episode influenced the chance of finding a treatable lesion or the chance of a further episode. The initial episodes varied from less than 5 minutes to longer than 3 weeks. There seemed to be no fundamental difference between transient ischemic attacks (TIAs) (less than 24 hours) and strokes which recover. However, 51% of those whose initial episode lasted less than 5 minutes had a subsequent stroke compared to 28% of those with an initial episode of more than 24 hours duration. Thirty percent of the former group who had angiograms had an operable lesion against 10% in the latter group. It seems that angiography has sufficiently high yield to be warranted in all patients where the initial attack lasted less than 30 minutes. In those with longer attacks the yield from angiography was much lower and noninvasive techniques should be considered in these patients, where available, prior to consideration for angiography. Investigation should be based on the degree of functional recovery and not on the arbitrary time division which normally divides TIAs and strokes. Bruits were the most reliable clinical indicators of stenosis. However the presence of intermittent claudication, hypertension and age over 50 were all more common in those with carotid stenosis.
本研究分析了234例从首次缺血发作中恢复的患者。目的是观察首次发作的持续时间是否会影响发现可治疗病变的机会或再次发作的机会。首次发作的时间从不到5分钟到超过3周不等。短暂性脑缺血发作（TIA，持续时间少于24小时）和恢复性中风之间似乎没有根本区别。然而，首次发作持续时间少于5分钟的患者中有51%随后发生了中风，而首次发作持续时间超过24小时的患者中这一比例为28%。前一组接受血管造影的患者中有30%有可手术治疗的病变，而后一组这一比例为10%。对于首次发作持续时间少于30分钟的所有患者，血管造影似乎具有足够高的阳性率，因此是必要的。对于发作时间较长的患者，血管造影的阳性率要低得多，在考虑进行血管造影之前，对于这些患者，如果有可用的非侵入性技术，应予以考虑。检查应基于功能恢复的程度，而不是基于通常区分TIA和中风的任意时间划分。血管杂音是狭窄最可靠的临床指标。然而，间歇性跛行、高血压和50岁以上的年龄在颈动脉狭窄患者中更为常见。
