Streifler J Y, Eliasziw M, Benavente O R, Harbison J W, Hachinski V C, Barnett H J, Simard D
Department of Clinical Neurological Sciences, University of Western Ontario, London.
Arch Neurol. 1995 Mar;52(3):246-9. doi: 10.1001/archneur.1995.00540270034016.
The prognosis of amaurosis fugax has been considered to be favorable compared with that of hemispheric transient ischemic attacks. However, this has remained uncertain for patients with significant carotid stenosis as the assessment of progression of the disease has been confounded when patients undergo carotid endarterectomy. In the North American Symptomatic Carotid Endarterectomy Trial, patients with high-grade (70% to 99%) carotid stenosis were randomized to receive either medical or surgical treatment, thus making an unconfounded analysis possible.
We identified 129 medically treated patients with high-grade carotid stenosis who had their first-ever transient ischemic attack as the entry event into the trial. Fifty-nine patients with retinal transient ischemic attacks (RTIAs) were compared with 70 patients with hemispheric transient ischemic attacks (HTIAs).
Patients with HTIAs were older, with a higher prevalence of most risk factors for stroke. Average time of delay from the onset of transient ischemic attacks to medical treatment was longer for patients with RTIAs than for patients with HTIAs (48.5 vs 15.2 days). Kaplan-Meier estimates of the risk of ipsilateral stroke at 2 years were 16.6% +/- 5.6% for patients with RTIAs and 43.5% +/- 6.7% for patients with HTIAs (P = .002 for the difference in risk between RTIAs and HTIAs). From corresponding Cox's proportional hazards regression analyses, the risk of ipsilateral stroke ranged from 11.2% to 28.9% for patients with RTIAs and from 37.4% to 96.3% for patients with HTIAs across stenoses, spanning 75% to 95%. Overall, the relative risk of ipsilateral stroke (HTIAs compared with RTIAs) was 3.23 (95% confidence interval, 1.47 to 7.12), regardless of the degree of high-grade stenosis.
To our knowledge, this study is the first report on the expected outcome for medically treated patients with high-grade (70% to 99%) carotid stenosis in whom the first-ever event was either an RTIA or HTIA. The presence of RTIAs carries a considerable risk of ipsilateral strokes, particularly at higher degrees of stenosis. However, in comparison with HTIAs, patients with RTIAs still have a better prognosis.
与半球性短暂性脑缺血发作相比，人们一直认为一过性黑矇的预后较好。然而，对于有严重颈动脉狭窄的患者而言，这一点仍不确定，因为当患者接受颈动脉内膜切除术时，疾病进展的评估会受到干扰。在北美症状性颈动脉内膜切除术试验中，重度（70%至99%）颈动脉狭窄的患者被随机分为接受药物治疗或手术治疗两组，从而使得进行无干扰分析成为可能。
我们确定了129例接受药物治疗的重度颈动脉狭窄患者，他们首次发生短暂性脑缺血发作作为进入试验的起始事件。将59例视网膜短暂性脑缺血发作（RTIA）患者与70例半球性短暂性脑缺血发作（HTIA）患者进行比较。
HTIA患者年龄更大，大多数中风危险因素的患病率更高。RTIA患者从短暂性脑缺血发作开始到接受药物治疗的平均延迟时间比HTIA患者更长（48.5天对15.2天）。RTIA患者2年时同侧中风风险的Kaplan-Meier估计值为16.6%±5.6%，HTIA患者为43.5%±6.7%（RTIA和HTIA之间风险差异P = 0.002）。从相应的Cox比例风险回归分析来看，RTIA患者同侧中风风险在75%至95%的狭窄范围内为11.2%至28.9%，HTIA患者为37.4%至96.3%。总体而言，无论重度狭窄程度如何，同侧中风的相对风险（HTIA与RTIA相比）为3.23（95%置信区间，1.47至7.12）。
据我们所知，本研究是关于首次事件为RTIA或HTIA的接受药物治疗的重度（70%至99%）颈动脉狭窄患者预期结果的首份报告。RTIA的存在会带来同侧中风的相当大风险，尤其是在更高程度的狭窄时。然而，与HTIA相比，RTIA患者的预后仍然更好。
