Pedrini L, Cifiello B I, Pisano E, Comaggi S, D'Addato M
Department of Vascular Surgery, University of Bologna, Italy.
J Cardiovasc Surg (Torino). 1993 Dec;34(6):473-8.
The natural history of carotid lesions has generally been evaluated in anedoctal series or in clinical trials. The purpose of this study was to evaluate clinical and pathological modifications linked to an increasing waiting list in our region and the related medico-legal implications.
Neurological symptoms that occurred during the waiting period were evaluated in 282 out of 491 patients placed on the waiting list for a carotid stenosis less than 80% or without an unstable plaque. The other 202 patients cancelled their booking. Progression of carotid disease was evaluated by duplex scanning in 116 patients who had a duplex evaluation in our Department both at booking and at the time of operation.
The incidence of stroke in a mean waiting period of 8.9 months was 2.6% in symptomatic patients and 1.5% in asymptomatic, respectively; 39 (13.8%) patients experienced an ipsilateral TIA and 4.2% a carotid thrombosis (25% of which symptomatic). The crude mortality-rate was 2.4% with a 1% of related deaths. The cumulative actuarial hard end points rate (stroke, carotid thrombosis and related death) was 7.8% at 12 months and 19.8% at 18 months.
This study gives us data about the natural history of carotid stenosis in our country. The high morbidity and mortality-rate related to this lesion and particularly their occurrence within the first 3 months stress the urgency of treatment, and of the planning of specialized Departments in relation to the real incidence of the pathology in order to avoid medico-legal consequences.
颈动脉病变的自然史通常是在非正规系列研究或临床试验中进行评估的。本研究的目的是评估与本地区等待名单增加相关的临床和病理改变以及相关的医疗法律问题。
在491例因颈动脉狭窄小于80%或无不稳定斑块而被列入等待名单的患者中，对282例在等待期间出现的神经症状进行了评估。另外202例患者取消了预约。对116例在本科室预约时和手术时均进行了双功超声评估的患者，通过双功扫描评估颈动脉疾病的进展。
在平均8.9个月的等待期内，有症状患者的卒中发生率为2.6%，无症状患者为1.5%；39例（13.8%）患者发生同侧短暂性脑缺血发作，4.2%发生颈动脉血栓形成（其中25%有症状）。粗死亡率为2.4%，相关死亡占1%。累积精算硬终点发生率（卒中、颈动脉血栓形成和相关死亡）在12个月时为7.8%，在18个月时为19.8%。
本研究为我国颈动脉狭窄的自然史提供了数据。与该病变相关的高发病率和死亡率，尤其是在前3个月内的发生情况，强调了治疗的紧迫性，以及根据该疾病的实际发病率规划专科科室以避免医疗法律后果的紧迫性。
