Moore W S, Kempczinski R F, Nelson J J, Toole J F
Department of Surgery, University of California at Los Angeles School of Medicine, California.
Stroke. 1998 Oct;29(10):2018-25. doi: 10.1161/01.str.29.10.2018.
We sought to determine the incidence of recurrent carotid stenosis in patients in the Asymptomatic Carotid Atherosclerosis Study (ACAS) who had undergone carotid endarterectomy and were prospectively followed with Doppler ultrasound for up to 5 years.
The ACAS database was interrogated to determine the rate of recurrent carotid stenosis (>/=60%) based up angiogram-validated Doppler data, with a 90% and a 95% positive predictive value, as well as information concerning the technologists' interpretation of percent stenosis. These 3 parameters are reported for each of 3 time intervals: within 3 months of operation (residual disease), between 3 and 18 months (early restenoses), and between 18 and 60 months (late restenosis).
Of the 825 patients randomized to the surgical arm of the study, 720 actually underwent carotid endarterectomy, and 645 had complete ultrasound data. The aggregate incidence of residual and recurrent carotid stenosis for all time intervals ranged from 12.7% to 20.4%, depending on the positive predictive value confidence level desired. Residual disease occurred in 4.1% to 6.5%; true, early restenosis was found in 7.6% to 11.4%; and late restenosis occurred in 1.9% to 4.9%. None of the traditional risk factors showed a statistically significant effect on recurrent stenosis. The use of patch angioplasty closure reduced overall risk of restenosis from 21.2% to 7.1%, from 16.7% to 4.6%, and from 27.4% to 8.2%, depending on the PPV confidence level desired (P<0.001). Of the 136 patients judged to have recurrent stenosis, only 8 (5.9%) underwent reoperation (only 1 for symptoms). There was no correlation between late stroke and recurrent stenosis.
Carotid endarterectomy is a durable procedure with a low rate of true restenosis, particularly when patch angioplasty is used to close the arteriotomy.
我们试图确定无症状性颈动脉粥样硬化研究（ACAS）中接受颈动脉内膜切除术并接受多普勒超声前瞻性随访长达5年的患者复发性颈动脉狭窄的发生率。
查询ACAS数据库，根据血管造影验证的多普勒数据确定复发性颈动脉狭窄（≥60%）的发生率，同时给出90%和95%的阳性预测值，以及技术人员对狭窄百分比的解读信息。这三个参数按三个时间间隔分别报告：术后3个月内（残余疾病）、3至18个月（早期再狭窄）和18至60个月（晚期再狭窄）。
在随机分配到该研究手术组的825例患者中，720例实际接受了颈动脉内膜切除术，645例有完整的超声数据。所有时间间隔内残余和复发性颈动脉狭窄的总发生率在12.7%至20.4%之间，具体取决于所需的阳性预测值置信水平。残余疾病发生率为4.1%至6.5%；真正的早期再狭窄发生率为7.6%至11.4%；晚期再狭窄发生率为1.9%至4.9%。没有传统危险因素对复发性狭窄有统计学意义的影响。使用补片血管成形术闭合可将再狭窄的总体风险从21.2%降至7.1%，从16.7%降至4.6%，从27.4%降至8.2%，具体取决于所需的PPV置信水平（P<0.001）。在136例被判定为复发性狭窄的患者中，只有8例（5.9%）接受了再次手术（仅1例有症状）。晚期卒中与复发性狭窄之间无相关性。
颈动脉内膜切除术是一种持久的手术，真正的再狭窄率较低，尤其是在使用补片血管成形术闭合动脉切开处时。
