Castaldo J E, Nelson J J, Reed J F, Longenecker J E, Toole J F
Department of Medicine, Lehigh Valley Hospital, Allentown, Pa., USA.
Arch Neurol. 1997 Oct;54(10):1267-71. doi: 10.1001/archneur.1997.00550220067016.
To examine whether patients in the Asymptomatic Carotid Atherosclerosis Study reported symptoms of cerebral and retinal ischemia promptly to the investigating team.
Cohort study within the Asymptomatic Carotid Atherosclerosis Study, a prospective, randomized, multicenter clinical trial, with a median follow-up time of 2.7 years.
Thirty-nine clinical sites across the United States and Canada.
Patients with asymptomatic carotid artery stenosis (> or = 60% reduction in diameter) who experienced either a transient ischemic attack (TIA) (n = 115) or stroke (n = 127) during the follow-up period, as verified by an external committee.
Proportion of patients who reported cerebrovascular symptoms to a study nurse or physician within 3 days of occurrence.
Thirty-seven patients (32.2%) experiencing TIA and 57 (44.9%) experiencing stroke reported symptoms to the study staff within 3 days of onset. For TIA, there was a statistically significant inverse association between prompt reporting and the amount of time a patient was enrolled in the study before the event occurred (48% with TIA occurring within 6 months vs 9% with TIA after year 3; P = .04). For stroke, there was a statistically significant association between prompt reporting and treatment arm (56% for the surgical vs 38% for the medical group; P = .05). For either TIA or stroke, none of the other factors examined were significantly associated with prompt reporting.
Despite extensive education and reinforcement, fewer than 40% of all first events were reported within 3 days and fewer than 25% were reported in less than 24 hours. Frequent outpatient evaluation of high-risk patients and careful review of symptoms is necessary to determine when asymptomatic carotid artery stenosis has become symptomatic to offer appropriate forms of therapy.
探讨无症状性颈动脉粥样硬化研究中的患者是否及时向研究团队报告脑和视网膜缺血症状。
无症状性颈动脉粥样硬化研究中的队列研究，这是一项前瞻性、随机、多中心临床试验，中位随访时间为2.7年。
美国和加拿大的39个临床地点。
无症状性颈动脉狭窄（直径减少≥60%）且在随访期间经历过短暂性脑缺血发作（TIA）（n = 115）或中风（n = 127）的患者，由外部委员会核实。
在症状出现3天内向研究护士或医生报告脑血管症状的患者比例。
37例（32.2%）经历TIA的患者和57例（44.9%）经历中风的患者在症状发作3天内向研究人员报告了症状。对于TIA，及时报告与事件发生前患者入组研究的时间存在统计学上的显著负相关（6个月内发生TIA的患者中有48%报告，而3年后发生TIA的患者中只有9%报告；P = 0.04）。对于中风，及时报告与治疗组存在统计学上的显著关联（手术组为56%，药物组为38%；P = 0.05）。对于TIA或中风，所检查的其他因素均与及时报告无显著关联。
尽管进行了广泛的教育和强化，但所有首次事件中不到40%在3天内报告，不到25%在不到24小时内报告。有必要对高危患者进行频繁的门诊评估并仔细审查症状，以确定无症状性颈动脉狭窄何时出现症状，从而提供适当的治疗形式。
