Mackey A E, Abrahamowicz M, Langlois Y, Battista R, Simard D, Bourque F, Leclerc J, Côté R
Neurovascular Research Center, Enfant-Jésus Hospital, Laval University, Quebec, Canada.
Neurology. 1997 Apr;48(4):896-903. doi: 10.1212/wnl.48.4.896.
Asymptomatic cervical atherosclerosis carries a variable risk of vascular events. We sought to identify patients with asymptomatic cervical bruits who may be at increased risk of developing ischemic events. We conducted a prospective multicenter cohort study of neurologically asymptomatic patients presenting a cervical bruit. Patients had biannual neurologic and carotid duplex evaluation. Association between ultrasonographic findings and vascular events, adjusting for common risk factors, was evaluated. Seven hundred fifteen patients were followed on average for 3.6 years. Mean age was 65 years. At initial visit, 357 subjects had a > or = 50% stenosis. Overall, 237 events occurred in 177 patients. Annual rate of all primary vascular events in patients with > or = 50% stenosis was 11.0% versus 4.2% in those with < 50% stenosis (p < 0.001). Annual rate of stroke and vascular death was 5.5% in the > or = 50% group compared with 1.9% in the < 50% group (p < 0.001). Yearly rate of unheralded ischemic stroke was 4.2% in subjects with > or = 80% stenosis and 1.4% in those with stenosis < 80% (p < 0.001). A stroke or TIA was ipsilateral to a > or = 80% stenosis in 66% of patients. Progression of carotid stenosis particularly to more than 80% was associated both with a higher rate of ipsilateral neurologic events and overall combined vascular events. Our data suggest that severity of carotid stenosis is the main risk factor predicting occurrence of neurologic and other vascular events. Yearly rate of ipsilateral stroke with > or = 50% carotid stenosis is low (1.4%) and most are nondisabling. Progression to > or = 80% or occlusion is associated with worse outcome.
无症状性颈动脉硬化具有不同程度的血管事件风险。我们试图识别那些可能发生缺血性事件风险增加的无症状性颈部杂音患者。我们对出现颈部杂音的无症状神经系统疾病患者进行了一项前瞻性多中心队列研究。患者每半年接受一次神经系统检查和颈动脉双功超声评估。在调整常见危险因素后，评估超声检查结果与血管事件之间的关联。715例患者平均随访3.6年。平均年龄为65岁。初次就诊时，357例受试者存在≥50%的狭窄。总体而言，177例患者发生了237次事件。狭窄≥50%的患者所有原发性血管事件的年发生率为11.0%，而狭窄<50%的患者为4.2%（p<0.001）。狭窄≥50%组的中风和血管性死亡年发生率为5.5%，而狭窄<50%组为1.9%（p<0.001）。狭窄≥80%的受试者未先兆缺血性中风的年发生率为4.2%，而狭窄<80%的受试者为1.4%（p<0.001）。66%的患者中风或短暂性脑缺血发作（TIA）与≥80%的狭窄同侧。颈动脉狭窄的进展，尤其是进展到超过80%，与同侧神经系统事件和总体合并血管事件的发生率较高相关。我们的数据表明，颈动脉狭窄的严重程度是预测神经系统和其他血管事件发生的主要危险因素。颈动脉狭窄≥50%时同侧中风的年发生率较低（1.4%），且大多数无致残性。进展到≥80%或闭塞与更差的预后相关。
