旨在调查颈内动脉 (ICA) 狭窄进展的自然史。 这项单机构回顾性队列研究分析了 2015 年至 2022 年经双功能超声 (DUS) 诊断为颈内动脉狭窄 50% 或以上的患者。受试者选自我们机构 IAC 认可的非介入血管实验室数据库。主要结局是指数研究后疾病进展、卒中或血运重建的发生率。进展被定义为狭窄分类类别的增加。影像、人口统计和临床数据是通过数据库挖掘查询从我们机构的 EMR 中获得的。在患者和动脉水平上对病例进行分析，严重程度对应于指数和随访研究中 ICA 狭窄的最大程度。在 467 名患者的 577 条动脉中，指数研究时的平均队列年龄为 73.5±8.9 岁45.0% (n=210) 为女性。患者接受 DUS 随访的时间平均为 42.2±22.7 个月。在 577 条动脉中，指数成像研究中 65.5% (n=378) 具有中度 (50-69%) 狭窄，23.7% (n=137) 具有重度 (70-99%) 狭窄，10.7% (n=62) ）被遮挡。这三组在年龄、高血压、高脂血症患病率以及最佳药物治疗比例方面存在显着差异。在 467 名患者队列中，56.5% (n=264) 接受了最佳药物治疗，定义为戒烟、使用抗血小板药物、他汀类药物以及指定的抗高血压和降血糖药物治疗。受影响动脉的平均进展时间为 28.0±20.5 个月。在诊断时患有非闭塞性疾病的动脉中，21.3% (n=123) 的狭窄程度有所进展。年龄较大、糖尿病和血管炎病史与狭窄进展相关，而抗血小板药物的使用往往会降低进展率。在 467 名患者中，5.6%（n=26）出现症状；其中，38.5%（n=10）患有缺血性中风，26.9%（n=7）患有半球短暂性脑缺血发作，11.5%（n=3）患有短暂性黑蒙，23.1%（n=6）有其他症状。头颈癌病史与症状发展呈正相关。在 577 条受影响的动脉中，16.6% (n=96) 接受了干预； 81% (n=78) 的干预措施针对无症状疾病，19% (n=18) 针对有症状疾病。没有患者水平因素与干预风险相关。大量颈动脉狭窄患者会出现疾病进展。医生应考虑对所有颈动脉疾病患者进行长期监测，并更加关注那些具有病情进展危险因素的患者，尤其是患有糖尿病和有血管炎病史的患者。版权所有 © 2023。由 Elsevier Inc. 出版。

To investigate the natural history of internal carotid artery (ICA) stenosis progression.This single-institution retrospective cohort study analyzed patients diagnosed with internal carotid artery stenosis of 50% or greater on duplex ultrasound (DUS) from 2015-2022. Subjects were drawn from our institutional IAC-accredited noninterventional vascular laboratory database. Primary outcomes were incidences of disease progression, and stroke or revascularization after index study. Progression was defined as an increase in stenosis classification category. Imaging, demographic, and clinical data was obtained from our institutional EMR via a database mining query. Cases were analyzed at the patient and artery levels, with severity corresponding to the greatest degree of ICA stenosis on index and follow-up studies.Of 577 arteries in 467 patients, mean cohort age was 73.5±8.9 years at the time of the index study and 45.0% (n=210) were female. Patients were followed with DUS for a mean of 42.2±22.7 months. Of 577 arteries, 65.5% (n=378) at the index imaging study had moderate (50-69%) stenosis, 23.7% (n=137) had severe (70-99%) stenosis, and 10.7% (n=62) were occluded. These three groups had significant differences in age, hypertension, hyperlipidemia prevalence, and proportion on best medical therapy. Of the 467 patient cohort, 56.5% (n=264) were on best medical therapy, defined as smoking cessation, treatment with an antiplatelet agent, statin, and antihypertensive and glycemic agents as indicated. Mean time to progression for affected arteries was 28.0±20.5 months. Of those arteries with nonocclusive disease at diagnosis, 21.3% (n=123) progressed in their level of stenosis. Older age, diabetes, and a history of vasculitis were associated with stenosis progression, while antiplatelet agent use trended towards decreased progression rates. Of the 467 patients, 5.6% (n=26) developed symptoms; of those, 38.5% (n=10) had ischemic strokes, 26.9% (n=7) had hemispheric transient ischemic attacks, 11.5% (n=3) had amaurosis fugax, and 23.1% (n=6) had other symptoms. A history of head and neck cancer was positively associated with symptom development. Of 577 affected arteries, 16.6% (n=96) underwent intervention; 81% (n=78) of interventions were for asymptomatic disease and 19% (n=18) were for symptomatic disease. No patient level factors were associated with risk of intervention.A significant number of carotid stenosis patients experience progression of disease. Physicians should consider long term surveillance on all patients with carotid disease, with increased attention paid to those with risk factors for progression, particularly those with diabetes and a history of vasculitis.Copyright © 2023. Published by Elsevier Inc.