Prospective controlled study of the natural history of asymptomatic 60 % to 69 % carotid stenosis according to ultrasonic plaque morphology
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- 作者：Ali F. AbuRahma ; Stefan P. Thiele ; John T. Wulu ; Jr
- 关键词：Thoracic aorta aneurysm ; aortotracheal fistula ; aortoesophageal fistula
- 刊名：Journal of Vascular Surgery
- 出版年：2002
- 出版时间：September 2002
- 年：2002
- 卷：36
- 期：3
- 页码：437-443
- 全文大小：89 K
文摘
Background/Purpose: In spite of the conclusions of the Asymptomatic Carotid Atherosclerosis Study, some clinicians are still reluctant to recommend carotid endarterectomy (CEA) for patients with asymptomatic ≥60 % carotid stenosis (ACS). This study analyzes the natural history of 60 % to 69 % ACS according to ultrasonic plaque morphology and its implication on treatment. Patient Population and Methods: During a 2-year period, patients with 60 % to 69 % ACS entered into a protocol of carotid duplex scan surveillance/clinical examination every 6 months. The ultrasonic plaque morphology was classified as heterogeneous (group A, n = 162) or homogeneous (group B, n = 229) with HDI 3000/HDI 5000 systems (Advanced Technology Laboratories, Bothwell, Wash). CEA was done if lesion progressed to ≥70 % stenosis or became symptomatic. Results: Three hundred eighty-two patients (391 arteries) were followed for a mean interval of 37 months. The clinical/demographic characteristics were similar for both groups. The incidence rate of future ipsilateral strokes was significantly higher in group A than in group B: 13.6 % versus 3.1 % (P = .0001; odds ratio [OR], 5). Similarly, the incidence rate of all neurologic events (stroke or transient ischemic attack [TIA]) was higher in group A than in group B: 27.8 % versus 6.6 % (P = .0001; OR, 5.5). Progression to ≥70 % stenosis was also higher in group A than in group B: 25.3 % versus 6.1 % (P = .0001; OR, 5.2). Forty-four late CEAs (27.2 % ) were done in group A (16 for stroke, 21 for TIA, and seven for ≥70 % ACS) versus 13 (5.7 % ) in group B (five for stroke, seven for TIA, and one for ≥70 % ACS; P = .0001; OR, 6.2). Conclusion: Patients with 60 % to 69 % ACS with heterogeneous plaque had a higher incidence rate of late stroke, TIA, and progression to ≥70 % stenosis than patients with homogeneous plaque. Prophylactic CEA for 60 % to 69 % ACS may be justified if associated with heterogeneous plaque. (J Vasc Surg 2002;36-437-42.)