Barrett Kevin M, Brott Thomas G
Department of Neurology-Cannaday 2E, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
Neurol Clin. 2006 Nov;24(4):681-95. doi: 10.1016/j.ncl.2006.05.003.
As operator experience and device technology continue to improve, the theoretic advantages of endovascular approaches to treat carotid occlusive disease may be closer to realization. Currently, data from controlled trials of CAS is minimal, but several multicenter RCTs comparing CAS to CEA are recruiting patients actively and preliminary results show procedural morbidity and mortality rates for CAS that compare favorably to CEA. Community-based experience with CAS continues to grow and further refinements in patient selection based on plaque morphology and other variables offer further hope that endovascular approaches to carotid occlusive disease may benefit selected patients. Given the proved efficacy and durability of CEA for treatment of extracranial carotid stenosis, surgical revascularization remains the recommended standard of care for most patients. CAS will have to be proved equivalent or superior to surgery and as cost-effective to facilitate its widespread acceptance as a treatment alternative for carotid occlusive disease.
随着术者经验和设备技术的不断进步，血管内介入治疗颈动脉闭塞性疾病的理论优势可能更接近实现。目前，关于颈动脉支架置入术（CAS）的对照试验数据极少，但多项比较CAS与颈动脉内膜切除术（CEA）的多中心随机对照试验正在积极招募患者，初步结果显示，CAS的手术发病率和死亡率与CEA相比具有优势。基于社区的CAS经验不断积累，基于斑块形态和其他变量的患者选择进一步优化，这为血管内介入治疗颈动脉闭塞性疾病可能使部分患者获益带来了更多希望。鉴于CEA治疗颅外颈动脉狭窄已证实的疗效和持久性，手术血运重建仍是大多数患者推荐的标准治疗方法。CAS必须被证明与手术等效或更优，且具有成本效益，才能促进其作为颈动脉闭塞性疾病治疗替代方案被广泛接受。
