Taylor Steve, Alcocer Francisco, Jordan William D
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA.
Vasc Endovascular Surg. 2003 Mar-Apr;37(2):79-87. doi: 10.1177/153857440303700201.
Endovascular therapies are now commonly used in many vascular sites. However, the role for carotid angioplasty and stenting (CAS) remains an unproven therapy with some potential benefits. Initial results of CAS were worse than the surgical standard of carotid endarterectomy (CEA) and did not meet American Heart Association guidelines. However, recent improvements have resulted in improved stroke morbidity rate that may approach that of CEA. Specifically, the embolic problem associated with CAS has been reduced with embolic protection devices, but the ultimate effect of these protection devices remains uncertain. Initial comparison studies of CAS to CEA showed an unacceptably high stroke morbidity rate in the CAS group. As a result, multiple randomized clinical trials have been initiated to compare the results of CAS with embolic protection to that of CEA. While these studies are underway, the authors advocate a careful application of CAS to be used as a complementary tool for the carotid surgeon to use in special circumstances when CEA cannot be undertaken with acceptable morbidity. Furthermore, since the reported stroke morbidity rate of CAS exceeds the AHA recommendation for treatment of asymptomatic patients, most nonsurgical patients with asymptomatic disease should be treated with medical therapy.
血管内治疗目前在许多血管部位普遍使用。然而，颈动脉血管成形术和支架置入术（CAS）的作用仍是一种未经证实但有一些潜在益处的治疗方法。CAS的初始结果比颈动脉内膜切除术（CEA）这一手术标准更差，且不符合美国心脏协会的指南。然而，最近的改进已使中风发病率有所改善，可能接近CEA的水平。具体而言，使用栓子保护装置已降低了与CAS相关的栓塞问题，但这些保护装置的最终效果仍不确定。CAS与CEA的初始比较研究显示，CAS组的中风发病率高得令人难以接受。因此，已启动多项随机临床试验，以比较使用栓子保护装置的CAS与CEA的结果。在这些研究进行期间，作者主张谨慎应用CAS，作为颈动脉外科医生在无法以可接受的发病率进行CEA的特殊情况下使用的辅助工具。此外，由于报道的CAS中风发病率超过了美国心脏协会对无症状患者治疗的建议，大多数无症状疾病的非手术患者应接受药物治疗。
