Gates P C, Chambers B, Yan B, Chong W, Denton M
Neuroscience Department, Geelong Hospital, Geelong, Australia.
Intern Med J. 2006 Jul;36(7):445-51. doi: 10.1111/j.1445-5994.2006.01085.x.
The management of symptomatic and asymptomatic carotid stenosis has been a hotly debated topic for decades. The publication of four randomized controlled trials of carotid endarterectomy has clarified many of the issues. Patients with symptomatic carotid stenosis >70% benefit most with an absolute risk reduction of 17% over 2 years with numbers needed to treat of 3-6, whereas in patients with asymptomatic carotid stenosis >60%, the absolute risk reduction is 1% per annum (numbers needed to treat = 14-17). There is doubt about the benefit in women >70 years of age with asymptomatic stenosis. Carotid angioplasty and stenting is in its infancy and may one day supplant carotid endarterectomy as the treatment of choice; however, currently indications for this procedure include participation in randomized controlled trials, surgically inaccessible stenosis, in patients with combined symptomatic carotid and symptomatic coronary artery disease or in patients with severe co-morbidities that preclude formal carotid endarterectomy.
几十年来，有症状和无症状性颈动脉狭窄的治疗一直是一个备受争议的话题。四项颈动脉内膜切除术随机对照试验的发表澄清了许多问题。症状性颈动脉狭窄>70%的患者受益最大，2年内绝对风险降低17%，治疗所需人数为3至6人；而无症状性颈动脉狭窄>60%的患者，每年绝对风险降低1%（治疗所需人数=14至17人）。对于70岁以上无症状性狭窄的女性患者，其获益存在疑问。颈动脉血管成形术和支架置入术尚处于起步阶段，也许有一天会取代颈动脉内膜切除术成为首选治疗方法；然而，目前该手术的适应证包括参与随机对照试验、手术无法触及的狭窄、合并症状性颈动脉和症状性冠状动脉疾病的患者，或有严重合并症而无法进行正规颈动脉内膜切除术的患者。
