Robless P, Baxter A, Byrd S, Emson M, Halliday A
Academic Surgical Unit, St. Mary's Hospital, London, UK.
Int Angiol. 1998 Sep;17(3):187-93.
The ACST has randomised over 1670 patients to determine if carotid endarterectomy (CEA) prolongs stroke free survival versus best medical treatment alone. Some patients have had contralateral symptoms to the side under investigation, for which CEA may have been performed. This study aims to determine the prevalence of hemispheric cerebral infarcts in relation to prior contralateral symptoms.
Patients with preoperative CT or MR scans were divided into those with prior contralateral stroke, cortical TIA, amaurosis fugax or no symptoms.
There were 1144 patients with preoperative CT and 170 patients with MR scans. Incidence of contralateral hemispheric CT and MR infarcts were 19% (222/1144) and 20% (34/170) respectively. Those with prior contralateral stroke (141) had the highest incidence of hemispheric CT infarcts (62%). Those with TIA (129) had a 30% incidence of CT infarct. Incidence of hemispheric CT infarcts were 17% with amaurosis fugax (46) and 10% with no prior symptoms (803). Mantel-Haenszel test for linear association was significant (p < 0.001) for increasing severity of symptoms. Considering MR scans, those with prior contralateral stroke (17) had the highest incidence of hemispheric MR infarcts (53%). Patients with TIA (23) or amaurosis fugax (6) had a 27% incidence of MR infarction. Those with no prior symptoms (121) had a 14% incidence of MR infarcts. Mantel-Haenszel test was significant (p < 0.001).
In the ACST, currently asymptomatic patients have an incidence of contralateral hemispheric CT and MR infarcts proportional to the severity of prior contralateral symptoms.
无症状颈动脉狭窄试验（ACST）已将超过1670名患者随机分组，以确定与单纯最佳药物治疗相比，颈动脉内膜切除术（CEA）是否能延长无卒中生存期。部分患者在接受检查的一侧出现对侧症状，对此可能已实施了CEA。本研究旨在确定与既往对侧症状相关的半球性脑梗死的患病率。
术前进行CT或磁共振成像（MR）扫描的患者被分为有既往对侧卒中、皮质短暂性脑缺血发作（TIA）、一过性黑矇或无症状的患者。
有1144例患者进行了术前CT扫描，170例患者进行了MR扫描。对侧半球CT和MR梗死的发生率分别为19%（222/1144）和20%（34/170）。有既往对侧卒中的患者（141例）半球CT梗死的发生率最高（62%）。有TIA的患者（129例）CT梗死的发生率为30%。一过性黑矇患者（46例）半球CT梗死的发生率为17%，无既往症状的患者（803例）为10%。症状严重程度增加时，线性关联的曼特尔-亨塞尔检验具有显著性（p<0.001）。考虑MR扫描，有既往对侧卒中的患者（17例）半球MR梗死的发生率最高（53%）。有TIA（23例）或一过性黑矇（6例）的患者MR梗死的发生率为27%。无既往症状的患者（121例）MR梗死的发生率为14%。曼特尔-亨塞尔检验具有显著性（p<0.001）。
在ACST中，目前无症状的患者对侧半球CT和MR梗死的发生率与既往对侧症状的严重程度成正比。
