Eliasziw M, Streifler J Y, Fox A J, Hachinski V C, Ferguson G G, Barnett H J
Clinical Trials Resources Group, John P. Robarts Research Institute, London, Ontario, Canada.
Stroke. 1994 Feb;25(2):304-8. doi: 10.1161/01.str.25.2.304.
The importance of carotid plaque ulceration as a cause of cerebral ischemic symptoms remains uncertain. Moreover, its prominence in symptomatic patients with severe carotid stenosis is unknown.
The association between angiographically defined plaque ulceration and risk of subsequent stroke was assessed using Cox proportional hazards regression in 659 patients with severe (70% to 99%) carotid stenosis from the North American Symptomatic Carotid Endarterectomy Trial.
Treatment assignment (medical versus surgical) and degree of ipsilateral stenosis were identified as having a significant influence on the results. The risk of ipsilateral stroke at 24 months for medically treated patients with ulcerated plaques increased incrementally from 26.3% to 73.2% as the degree of stenosis increased from 75% to 95%. For patients with no ulcer, the risk of stroke remained constant at 21.3% for all degrees of stenosis. The net result yielded relative risks of stroke (ulcer versus no ulcer) ranging from 1.24 (95% confidence interval, 0.61 to 2.52) to 3.43 (95% confidence interval, 1.49 to 7.88). Conversely, for surgically treated patients with antecedent presence of an ulcerated plaque, the risk of stroke increased slightly at the highest degrees of stenosis. Overall, carotid endarterectomy reduced the risk of ipsilateral stroke at 24 months by at least 50%. Similar results were obtained for risk of major ipsilateral stroke and risk of all strokes and death.
The presence of angiographically defined ulceration for medically treated symptomatic patients is associated with an increased risk of stroke. The risk of stroke more than doubles at higher degrees of stenosis. Carotid endarterectomy is beneficial in substantially reducing the risk of stroke, regardless of plaque ulceration and degree of severe carotid stenosis.
颈动脉斑块溃疡作为脑缺血症状病因的重要性仍不确定。此外，其在有症状的重度颈动脉狭窄患者中的突出程度也未知。
在北美症状性颈动脉内膜切除术试验的659例重度（70%至99%）颈动脉狭窄患者中，使用Cox比例风险回归评估血管造影定义的斑块溃疡与后续卒中风险之间的关联。
治疗分配（药物治疗与手术治疗）和同侧狭窄程度被确定对结果有显著影响。随着狭窄程度从75%增加到95%，接受药物治疗的有溃疡斑块患者在24个月时同侧卒中风险从26.3%逐渐增加到73.2%。对于无溃疡的患者，所有狭窄程度的卒中风险均保持在21.3%不变。最终结果显示，卒中的相对风险（溃疡与无溃疡）范围为1.24（95%置信区间，0.61至2.52）至3.43（95%置信区间，1.49至7.88）。相反，对于术前有溃疡斑块的手术治疗患者，在最高狭窄程度时卒中风险略有增加。总体而言，颈动脉内膜切除术在24个月时将同侧卒中风险降低了至少50%。对于同侧严重卒中风险、所有卒中和死亡风险也获得了类似结果。
对于接受药物治疗的有症状患者，血管造影定义的溃疡的存在与卒中风险增加相关。在更高程度的狭窄时，卒中风险增加一倍以上。无论斑块溃疡情况和重度颈动脉狭窄程度如何，颈动脉内膜切除术在大幅降低卒中风险方面是有益的。
