Paciaroni M, Caso V, Acciarresi M, Baumgartner R W, Agnelli G
Stroke Unit, University of Perugia, Ospedale Silvestrini, Sant'Andrea delle Fratte, Perugia 06126, Italy.
J Neurol Neurosurg Psychiatry. 2005 Oct;76(10):1332-6. doi: 10.1136/jnnp.2005.066936.
Current available data do not seem to support the strategy for carotid endarterectomy prior to surgical intervention in patients with asymptomatic carotid stenosis. However, in patients with coronary artery disease, synchronous carotid endarterectomy and coronary artery bypass grafting should be considered where there is a proven surgical risk of <3% with unilateral asymptomatic stenosis >60% or bilateral carotid stenosis >75% on the same side as the most severe stenosis. Clarification of the optimal strategy requires an adequately powered, multicentre, randomised clinical trial.
目前可得的数据似乎并不支持对无症状性颈动脉狭窄患者在手术干预前进行颈动脉内膜切除术的策略。然而,对于冠心病患者,如果经证实手术风险<3%,且存在单侧无症状性狭窄>60%或双侧颈动脉狭窄>75%(与最严重狭窄在同一侧),则应考虑同期进行颈动脉内膜切除术和冠状动脉旁路移植术。明确最佳策略需要进行一项有足够效力的多中心随机临床试验。