Naylor A R
Department of Vascular Surgery, Leicester Royal Infirmary, Leicester, UK.
J Cardiovasc Surg (Torino). 2007 Apr;48(2):161-80.
Most national and/or specialty driven guidelines recommend against the use of carotid angioplasty/stenting (CAS) in the management of otherwise low or standard risk patients with asymptomatic carotid disease outwith the protection of randomised trials. Despite this relatively clear advice, however, an increasing number of registries and single-centre series now include an ever increasing proportion of low-risk asymptomatic patients within their study cohort. Can this practice currently be justified in the absence of any quality randomised trial evidence? This paper reviews the primary and secondary analyses from the two major randomised trials in asymptomatic patients, discusses the current status of CAS and endarterectomy and highlights areas of controversy and consensus. It concludes with an appeal for all surgeons and interventionists to participate in one of the four randomised trials currently being performed around the world, so that future practice is driven by evidence rather than intuition.
大多数国家和/或专业领域的指南都不建议在没有随机试验保障的情况下，对其他方面风险较低或处于标准风险的无症状颈动脉疾病患者采用颈动脉血管成形术/支架置入术（CAS）进行治疗。然而，尽管有这条相对明确的建议，但越来越多的登记研究和单中心系列研究在其研究队列中纳入的低风险无症状患者比例却在不断增加。在缺乏任何高质量随机试验证据的情况下，目前这种做法是否合理呢？本文回顾了两项针对无症状患者的主要随机试验的主要和次要分析，讨论了CAS和内膜切除术的现状，并突出了争议和共识领域。文章最后呼吁所有外科医生和介入专家参与目前正在全球范围内进行的四项随机试验之一，以便未来的治疗实践以证据而非直觉为导向。
