Avtor/Urednik | Hartog, Anne G. den; Halliday, Alison; Hayter, Elizabeth; Pan, Hongchao; Kong, Xing; Moll, Frans L.; Borst, Gert Jan de; Flis, Vojko; Miksić, Kazimir; Štirn, Barbara; Tetičkovič, Erih | |
Naslov | Risk of stroke from new carotid artery occlusion in the Asymptomatic Carotid Surgery Trial-1 | |
Tip | članek | |
Vol. in št. | Letnik 44, št. 6 | |
Leto izdaje | 2013 | |
Obseg | str. 1652-1659 | |
ISSN | 0039-2499 - Stroke; a journal of cerebral circulation | |
Jezik | eng | |
Abstrakt | Background and Purpose - In the Asymptomatic Carotid Surgery Trial-1 (ACST-1), 3120 patients with tight asymptomatic carotid stenosis were randomly assigned to medical treatment alone or to carotid endarterectomy and appropriate medication. Successful carotid endarterectomy significantly reduced 10-year stroke risk in younger patients. This study was undertaken to determine the risk of new occlusion and stroke during trial follow-up. Methods - Patients with contralateral occlusion at trial entry (n=276) or incomplete duplex follow-up (n=137) were excluded. Risk of occlusion and stroke in patients with occlusion was estimated by Kaplan-Meier analysis. Cox proportional hazard regression models were used to determine risk factors for developing new occlusion and stroke. Results - Median follow-up in 2707 patients was 80.0 months (interquartile range, 52.0-115.0). New occlusions occurred in 197 patients (1.1% per annum) but were more likely to occur in arteries with tight stenosis and in unoperated patients. Overall risk of stroke was 7.6% (95% confidence interval [CI], 6.6-8.7) and 15.5% (95% CI, 13.6-17.4) at 5 and 10 years, respectively; for patients with new occlusion, this significantly increased to 17.0% (95% CI, 11.6-22.4) and 20.8% (95% CI, 14.1-26.2), respectively (P<0.001). Stroke was significantly more likely to occur in patients developing occlusion (hazard ratio, 1.78; 95% CI, 1.26-2.51) irrespective of allocated treatment. Conclusions - New occlusions were uncommon after carotid endarterectomy in ACST-1. During long-term follow-up, occlusion and stroke were commoner among patients with >/= 70% stenosis, most of whom had not undergone carotid endarterectomy. Occlusion was an independent prognostic risk factor for occurrence of stroke. | |
Proste vsebinske oznake | karotidna arterija, stenoza možganska kap karotidna endarterektomija karotidna okluzivna bolezen karotidna stenoza, zdravljenje karotidna stenoza, zapleti fibrinolitiki antihipertenzivi dejavniki tveganja ponovitev bolezni sledilne študije |