颈动脉内膜切除术后采用临床随访而非双功超声监测。

Clinical follow-up rather than duplex surveillance after carotid endarterectomy.

作者信息

Golledge J, Cuming R, Ellis M, Beattie D K, Davies A H, Greenhalgh R M

机构信息

Department of Surgery, Charing Cross and Westminster Medical School, London, United Kingdom.

出版信息

J Vasc Surg. 1997 Jan;25(1):55-63. doi: 10.1016/s0741-5214(97)70321-5.

DOI:10.1016/s0741-5214(97)70321-5

PMID:9013908

Abstract

PURPOSE

The value of duplex surveillance and the significance of contralateral carotid disease after endarterectomy have been assessed.

METHODS

Three hundred five patients were observed prospectively after carotid endarterectomy for a median time of 36 months (range, 6 to 96 months), with duplex surveillance performed at 1 day; 1 week; 3, 6, 9, and 12 months; and then each year after endarterectomy.

RESULTS

Thirty patients (10%) had ipsilateral symptoms (13 strokes, 17 transient ischemic attacks [TIAs]) at a median time of 6 months (range, 0 to 60 months). Life table analysis demonstrated that ipsilateral stroke was equally common for patients who had > or = 50% restenosis (3% at 36 months) and those who did not (6% at 36 months, p > 0.5). Twenty-three patients (8%) developed symptoms (stroke 5, TIA 14) attributable to the contralateral carotid artery at a median time of 9 months (range, 0 to 36 months) after endarterectomy. By life table analysis, 40% of patients with 70% to 99%, 6% with 50% to 69%, 1% with < 50% contralateral internal carotid stenosis, and 5% with contralateral carotid occlusion at the time of endarterectomy had a contralateral TIA in the 36 months after endarterectomy (p < 0.01). However, contralateral stroke was not significantly more common for patients with severe contralateral internal carotid stenosis demonstrated at the time of endarterectomy (< 50% stenosis, 0%; 50% to 69%, 3%; 70% to 99%, 7%; occlusion, 6% stroke rate at 36 months). Seven of the 32 patients who developed progression of contralateral disease had a TIA, compared with 11 of 227 patients who did not develop progression of contralateral disease (p < 0.01). None of the 12 patients who progressed from a < 70% to a 70% to 99% contralateral stenosis had a stroke.

CONCLUSIONS

After carotid endarterectomy restenosis is rarely associated with symptoms; contralateral stroke is rare and is not associated with progressive internal carotid artery disease suitable for endarterectomy. This study has shown no benefit from long-term duplex surveillance after carotid endarterectomy. Selective clinical follow-up of patients who have high-grade contralateral stenoses would appear more appropriate.

摘要

目的

评估双功超声监测的价值以及动脉内膜切除术后对侧颈动脉疾病的意义。

方法

对305例患者在颈动脉内膜切除术后进行前瞻性观察，中位观察时间为36个月（范围6至96个月），术后1天、1周、3、6、9和12个月以及之后每年进行双功超声监测。

结果

30例患者（10%）出现同侧症状（13例卒中，17例短暂性脑缺血发作[TIA]），中位时间为6个月（范围0至60个月）。生命表分析显示，再狭窄≥50%的患者同侧卒中发生率（36个月时为3%）与未达到该标准的患者（36个月时为6%，p>0.5）相同。23例患者（8%）在动脉内膜切除术后中位时间9个月（范围0至36个月）出现对侧颈动脉所致症状（5例卒中，14例TIA）。通过生命表分析，动脉内膜切除时对侧颈内动脉狭窄70%至99%的患者中40%、50%至69%的患者中6%、<50%的患者中1%以及对侧颈动脉闭塞的患者中5%在动脉内膜切除术后36个月内发生对侧TIA（p<0.01）。然而，动脉内膜切除时显示严重对侧颈内动脉狭窄的患者对侧卒中发生率并无显著增加（<50%狭窄，0%；50%至69%，3%；70%至99%，7%；闭塞，36个月时卒中发生率6%）。发生对侧疾病进展的32例患者中有7例出现TIA，而未发生对侧疾病进展的227例患者中有11例出现TIA（p<0.01）。从对侧狭窄<70%进展至70%至99%的12例患者中无一例发生卒中。