Loftus M L, Schumacher H C, Meyers P M
Department of Neurology, Columbia University College of Physicians and Surgeons, Neurological Institute and Columbia Presbyterian Medical Center, 710 West 168th Street, New York, NY 10032, USA.
Minerva Cardioangiol. 2006 Oct;54(5):679-85.
Carotid artery angioplasty with stenting (CAS) has emerged as a viable alternative to endarterectomy for the treatment of occlusive vascular disease. Advances in endovascular techniques and the improvement of specialized stents have served to rapidly close the gap with the traditional gold standard surgery. Furthermore, the development of cerebral embolic protection devices has reduced the occurrence of distal embolization of atheromatous material during such interventions and has reduced periprocedural stroke rates considerably. Continued improvements in distal embolic protection have further improved the risk profile of CAS, and increased operator experience with these interventional procedures has also been shown to reduce periprocedural complication rates. Outcomes may continue to improve as more providers gain experience with the evolving endovascular device technology, and several prospective clinical trials are currently investigating the efficacy of CAS with embolization protection versus endarterectomy in different cohorts. This review will survey the background and current literature covering angioplasty and stenting for occlusive disease in the carotid arteries and discuss the current methods employed to prevent distal emboli during intervention.
颈动脉血管成形术加支架置入术（CAS）已成为治疗闭塞性血管疾病的一种可行的替代动脉内膜切除术的方法。血管内技术的进步和专用支架的改进迅速缩小了与传统金标准手术的差距。此外，脑栓塞保护装置的发展减少了此类干预过程中动脉粥样硬化物质远端栓塞的发生，并显著降低了围手术期卒中发生率。远端栓塞保护的持续改进进一步改善了CAS的风险状况，并且操作人员对这些介入手术经验的增加也已证明可降低围手术期并发症发生率。随着越来越多的医疗人员积累了使用不断发展的血管内装置技术的经验，治疗效果可能会持续改善，并且目前有几项前瞻性临床试验正在研究不同队列中使用栓塞保护的CAS与动脉内膜切除术的疗效。本综述将概述颈动脉闭塞性疾病血管成形术和支架置入术的背景及当前文献，并讨论目前在干预过程中用于预防远端栓子的方法。
