Asymptomatic Carotid Artery Stenosis and the Risk of Ischemic Stroke According to Subtype in Patients With Clinical Manifest Arterial Disease

被引:92
作者
den Hartog, Anne G. [1 ]
Achterberg, Sefanja [2 ]
Moll, Frans L. [1 ]
Kappelle, L. Jaap [2 ]
Visseren, Frank L. J. [3 ]
van der Graaf, Yolanda [4 ]
Algra, Ale [2 ,4 ]
de Borst, Gert Jan [1 ]
机构
[1] Univ Med Ctr Utrecht, Dept Vasc Surg, NL-3508 GA Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Utrecht Stroke Ctr, Dept Neurol & Neurosurg, NL-3508 GA Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Dept Vasc Med, NL-3508 GA Utrecht, Netherlands
[4] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands
关键词
asymptomatic carotid artery stenosis; stroke; INTIMA-MEDIA THICKNESS; VASCULAR EVENTS; NORTHERN MANHATTAN; 2ND MANIFESTATIONS; SMART; TRIAL; CLASSIFICATION; ENDARTERECTOMY; DIAGNOSIS;
D O I
10.1161/STROKEAHA.111.669267
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Because best medical treatment is improving, the risk of stroke in asymptomatic carotid artery stenosis (ACAS) may decline. We evaluated the risk of ischemic stroke and stratified it according to stroke subtype in patients with ACAS during long-term follow-up. Methods-In total, 4319 consecutive patients in the Second Manifestations of Arterial disease study with clinically manifest arterial disease or specific risk factors, but without a history of cerebrovascular disease, were included. Degree of stenosis was evaluated with duplex ultrasound scanning. Strokes during follow-up were classified according to subtype. Cox-proportional hazard-regression models were used to evaluate the relationship between ACAS and future stroke. Results-We identified 293 (6.8%) patients with ACAS 50% to 99%, of whom 193 had 70% to 99% stenosis. In these subgroups, mean follow-up was 6.2 and 6.0 years, respectively. In total, 94 ischemic strokes occurred, of which 8 in ACAS 50% to 99% patients. The any territory annual ischemic stroke risk was 0.4% in 50% to 99% ACAS and 0.5% per year for 70% to 99% ACAS patients. The risk of ischemic stroke was not significantly increased in patients with ACAS 70% to 99% (hazard ratio, 1.5; 95% confidence interval, 0.7-3.5). Patients with ACAS 50% to 99% and ACAS 70% to 99% tended to have nonsignificantly more large vessel disease strokes (hazard ratio, 1.5; 95% confidence interval, 0.5-4.2 and hazard ratio, 1.7; 95% confidence interval, 0.5-5.6). Conclusions-Patients with clinically manifest arterial disease or type 2 diabetes mellitus have a low risk of developing ischemic stroke, irrespective of its subtype and independent of the degree of ACAS stenosis. (Stroke. 2013;44:1002-1007.)
引用
收藏
页码:1002 / 1007
页数:6
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