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Titolo:
NATURAL-HISTORY AND MANAGEMENT OF THE ASYMPTOMATIC, MODERATELY STENOTIC INTERNAL CAROTID-ARTERY
Autore:
ROCKMAN CB; RILES TS; LAMPARELLO PJ; GIANGOLA G; ADELMAN MA; STONE D; GUARESCHI C; GOLDSTEIN J; LANDIS R;
Indirizzi:
NYU,MED CTR,DEPT SURG,DIV VASC SURG,530 FIRST AVE,SUITE 6F NEW YORK NY 10016 NYU,MED CTR,DEPT SURG,DIV VASC SURG NEW YORK NY 10016
Titolo Testata:
Journal of vascular surgery
fascicolo: 3, volume: 25, anno: 1997,
pagine: 423 - 431
SICI:
0741-5214(1997)25:3<423:NAMOTA>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
ENDARTERECTOMY TRIAL; DUPLEX CRITERIA; STENOSIS; ANGIOGRAPHY; 70-PERCENT; BRUITS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
23
Recensione:
Indirizzi per estratti:
Citazione:
C.B. Rockman et al., "NATURAL-HISTORY AND MANAGEMENT OF THE ASYMPTOMATIC, MODERATELY STENOTIC INTERNAL CAROTID-ARTERY", Journal of vascular surgery, 25(3), 1997, pp. 423-431

Abstract

Purpose: Although it has been widely accepted as the evidence supporting prophylactic carotid endarterectomy, aspects of the Asymptomatic Carotid Atherosclerosis Study have left unease among clinicians who must decide which individuals without symptoms should undergo surgery. Additional confusion has been created by the fact that the several largerandomized trials investigating the efficacy of carotid endarterectomy have classified and analyzed different categories of carotid stenosis. In an effort to provide more information on the natural history of asymptomatic, moderate carotid artery stenosis (50% to 79%), we have reviewed data on approximately 500 arteries. Methods: Records of our vascular laboratory from 1990 to 1992 were reviewed. We identified 425 patients with asymptomatic, moderate carotid artery stenosis; 71 patients had bilateral stenoses in this category, resulting in 496 arteries for study. Results: The mean length of follow-up was 38 +/- 18 months. New ipsilateral strokes occurred in 16 (3.8%) patients. New ipsilateral transient ischemic attacks occurred in 25 (5.9%) patients. Documented progression of stenosis occurred in 48 (17%) of the 282 arteries for which a repeat duplex examination was available. Arteries that progressed to >80% stenosis were significantly more likely to have caused strokes than those that remained in the 50% to 79% range (10.4% vs 2.1%, p < 0.02). Conversely, arteries that remained stable in the degree of stenosis were significantly more likely to have remained asymptomatic than those that progressed (92.7% vs 62.5%, p < 0.001). With life-table analysis the estimated cumulative ipsilateral stroke rate was 0.85% at 1 year, 3.6% at 3 years, and 5.4% at 5 years. The respective estimated cumulative transient ischemic attack rates were 1.9%, 5.5%, and 6.3%. The respective estimated cumulative rates for progression of stenosis were 4.9%, 16.7%, and 26.5%. Life-table comparison of ipsilateral stroke revealed a significantly higher cumulative rate among arteries that progressed in the degree of stenosis than among those that remained stable (p < 0.001). Conclusions: Based on the low rate of permanent neurologic events in these cases, prophylactic carotid endarterectomy for the asymptomatic, moderately stenotic internal carotid artery cannot currently be recommended. The only factor that appears to predict increased risk for future stroke is progression of stenosis. Carefulfollow-up with serial repeat duplex examinations must be performed inthese patients. Until there are widely accepted duplex parameters that can provide all clinicians with accurate identification of arteries with narrowing corresponding to 60% stenosis as defined by the Asymptomatic Carotid Atherosclerosis Study, all surgeons will need to be aware of specifically how their noninvasive laboratories are deriving their results. For the many laboratories that continue to use the University of Washington criteria, 80% should remain the level above which prophylactic carotid endarterectomy is warranted.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/10/20 alle ore 12:23:39