Henry M, Polydorou A, Henry I, Anagnostopoulou I S, Polydorou I A, Hugel M
Clinic of Cardiology, Nancy, France.
J Cardiovasc Surg (Torino). 2006 Oct;47(5):519-46.
A carotid stenosis is responsible for about 30% of strokes occurring. Carotid endarterectomy (CEA) is considered to be the gold standard treatment of a carotid stenosis. Carotid angioplasty and stenting (CAS) is emerging as a new alternative treatment for a carotid artery stenosis, but the risk of neurological complications and brain embolism remains the major drawback to this procedure. Therefore, in order to reduce the risks, we need: 1) good indications, good patient and lesion selection; 2) correct techniques; 3) brain protection devices (cerebral protection devices should be routinely used and are mandatory for any procedure); 4) 3 types of protection devices are available, but filters are the most commonly used (all protection devices have limitations and cannot prevent from all embolic events; however, neurological complications can be reduced by 60%); 5) a good choice of the stent and correct implantation (all stents are not equivalent and have different geometrical effects); 6) pharmacological adjuncts; 7) a good team. Recent studies have shown that CAS has superior short-term outcomes than CEA in high surgical risk patients, but there are enough reported data to conclude that CAS is also not inferior to CEA in low-risk patients. CAS under protection is the standard of care and is maybe becoming the gold standard treatment of a carotid stenosis at least in some subgroups of patients.
约30%的中风是由颈动脉狭窄引起的。颈动脉内膜切除术（CEA）被认为是治疗颈动脉狭窄的金标准。颈动脉血管成形术和支架置入术（CAS）正作为一种治疗颈动脉狭窄的新的替代方法出现，但神经并发症和脑栓塞的风险仍然是该手术的主要缺点。因此，为降低风险，我们需要：1）明确的适应症，对患者和病变进行良好的选择；2）正确的技术；3）脑保护装置（脑保护装置应常规使用，对任何手术都是必需的）；4）有3种类型的保护装置可用，但滤网是最常用的（所有保护装置都有局限性，不能预防所有栓塞事件；然而，神经并发症可减少60%）；5）对支架进行良好的选择并正确植入（并非所有支架都等效，具有不同的几何效应）；6）药物辅助；7）一个优秀的团队。最近的研究表明，在高手术风险患者中，CAS的短期疗效优于CEA，但有足够的报道数据表明，在低风险患者中，CAS也不逊色于CEA。在保护措施下进行CAS是治疗的标准，至少在某些患者亚组中可能正成为治疗颈动脉狭窄的金标准。
