Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. The North American Symptomatic Carotid Endarterectomy Trail.

Abstract:

BACKGROUND AND PURPOSE:The estimated prevalence of intracranial atherosclerotic disease (IAD) in patients with stenosis of the extracranial internal carotid artery (ICA) varies between 20% and 50%. The benefits of carotid endarterectomy (CE) in patients with both IAD and symptomatic extracranial ICA stenosis are uncertain. METHODS:The association between IAD and other vascular risk factors and with the risk of stroke at 3 years were studied in patients with symptomatic extracranial ICA stenosis who participated in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Since the NASCET protocol excluded severe IAD, only a modest number of patients in this category could be studied. RESULTS:IAD was observed in one third of the patients. In medically treated patients, the relative risk of stroke associated with IAD varied from 1.3 (95% CI, 0.9 to 1.9) with extracranial ICA stenosis of <50% to 1.8 (95% CI, 1.1 to 3.2) with 85% to 99% ICA stenosis. In contrast, IAD did not affect the risk of stroke among surgically treated patients. To prevent 1 stroke ipsilateral to the symptomatic ICA stenosis over 3 years in patients who have also IAD, 12 patients with 50% to 69%, 5 patients with 70% to 84%, and 3 patients with 85% to 99% ICA stenosis have to undergo CE. In patients without IAD these numbers are 26, 7, and 6, respectively. CONCLUSIONS:IAD is an independent risk factor for subsequent stroke in medically treated patients with symptomatic ICA stenosis. CE reduces this risk. The additional risk imposed by IAD in medically treated patients enhances the value of CE in patients with moderate symptomatic extracranial ICA stenosis. Detection of IAD, requiring angiography, is an important prelude to planning CE in symptomatic patients with moderate extracranial ICA stenosis.

journal_name

Stroke

journal_title

Stroke

authors

Kappelle LJ,Eliasziw M,Fox AJ,Sharpe BL,Barnett HJ

doi

10.1161/01.str.30.2.282

subject

Has Abstract

pub_date

1999-02-01 00:00:00

pages

282-6

issue

2

eissn

0039-2499

issn

1524-4628

journal_volume

30

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

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