所有缺血性卒中约有 10%至 15%与颈动脉狭窄有关。 约 1/3 的卒中的病因是血栓栓塞,动脉粥样硬化性颈动脉狭窄是最常见的单一病因。[3]Gensicke H, Engelter S, Bonati L. Endovascular treatment for carotid artery stenosis [in German]. Ther Umsch. 2012;69:523-535.http://www.ncbi.nlm.nih.gov/pubmed/22923356?tool=bestpractice.com
曼哈顿北部的人群,在每 10 万黑人中有 17 人(95% CI 8-26)、每 10 万西班牙裔人中有 9 人(95% CI 5-13)、每 10 万白人中有 5 人(95%CI 2-8)由于颈动脉狭窄导致卒中。[4]Sacco RL, Boden-Albala B, Gan R, et al. Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study. Am J Epidemiol. 1998;147:259-268.http://aje.oxfordjournals.org/content/147/3/259.longhttp://www.ncbi.nlm.nih.gov/pubmed/9482500?tool=bestpractice.com 在德国卒中中心进行的汇总研究中,颈动脉狭窄是 20.9%的卒中患者的病因。[5]Grau AJ, Weimar C, Buggle F, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001;32:2559-2566.http://stroke.ahajournals.org/content/32/11/2559.longhttp://www.ncbi.nlm.nih.gov/pubmed/11692017?tool=bestpractice.com 对于 >70 岁以上的男性和女性,受到无症状颈动脉狭窄影响的比例分别约 7%和 12%。[6]de Weerd M, Greving JP, de Jong AW, et al. Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke. 2009;40:1105-1113.http://stroke.ahajournals.org/content/40/4/1105.longhttp://www.ncbi.nlm.nih.gov/pubmed/19246704?tool=bestpractice.com
卒中是英国和美国的第五大死因。英国每年有约 15.2 万例卒中。[7]Stroke Association. State of the nation: stroke statistics. January 2016. http://www.stroke.org.uk/ (last accessed 19 August 2016).https://www.stroke.org.uk/resources/state-nation-stroke-statistics 在美国,每年有 61 万患者新发卒中,每年有 13 万人死于脑血管疾病。卒中也是美国老年人致残的首要原因。Framingham 研究证实,年龄增长、高血压、糖尿病、吸烟和心血管疾病是卒中的危险因素。[8]Wolf PA, D'Agostino RB, Kannel WB, et al. Cigarette smoking as a risk factor for stroke. The Framingham Study. JAMA. 1988;259:1025-1029.http://www.ncbi.nlm.nih.gov/pubmed/3339799?tool=bestpractice.com[9]Kannel WB, Wolf PA, McGee DL, et al. Systolic blood pressure, arterial rigidity, and risk of stroke. The Framingham study. JAMA. 1981;245:1225-1229.http://www.ncbi.nlm.nih.gov/pubmed/7206111?tool=bestpractice.com[10]Howard G, Manolio TA, Burke GL, et al. Does the association of risk factors and atherosclerosis change with age? An analysis of the combined ARIC and CHS cohorts. The Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS) investigators. Stroke. 1997;28:1693-1701.http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=9303011http://www.ncbi.nlm.nih.gov/pubmed/9303011?tool=bestpractice.com 尽管在过去的 20 年间,卒中的死亡率已经降低了 50%,但是 21% 的存活者仍会发生再次卒中,7% 的存活者有第三次卒中发作。[11]Sacco RL, Wolf PA, Kannel WB, et al. Survival and recurrence following stroke. The Framingham study. Stroke. 1982;13:290-295.http://stroke.ahajournals.org/content/13/3/290.longhttp://www.ncbi.nlm.nih.gov/pubmed/7080120?tool=bestpractice.com 至少 40%的患者需要长期护理。[12]Elkins JS, Johnston SC. Thirty-year projections for deaths from ischemic stroke in the United States. Stroke. 2003;34:2109-2112.http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=12881608http://www.ncbi.nlm.nih.gov/pubmed/12881608?tool=bestpractice.com