Touzé Emmanuel, Calvet David, Chatellier Gilles, Mas Jean-Louis
René Descartes University, Department of Neurology and Stroke Unit, Centre Hospitalier Sainte-Anne, Paris, France.
Curr Opin Neurol. 2008 Feb;21(1):56-63. doi: 10.1097/WCO.0b013e3282f313d2.
Carotid angioplasty and stenting is potentially an alternative to carotid endarterectomy in carotid stenosis, but it remains unclear whether it confers significant advantages over carotid endarterectomy. We reviewed evidence on carotid angioplasty and stenting in carotid stenosis.
Carotid angioplasty and stenting is neither safer nor associated with better short-term outcomes in patients with symptomatic carotid stenosis who are not at increased surgical risk. It has not been evaluated sufficiently in patients with asymptomatic carotid stenosis who are good candidates for carotid endarterectomy. Patients at perceived high surgical risk may be good candidates for carotid angioplasty and stenting, but there is variability in the definition of high risk, and this procedure has been compared with carotid endarterectomy in only one small randomized trial. Many registries suggest that carotid angioplasty and stenting is as safe as carotid endarterectomy, but it is uncertain whether those patients really benefit from any carotid revascularization strategy.
Carotid endarterectomy is still the 'gold standard' for treatment of patients with carotid stenosis who are good candidates for carotid endarterectomy. Although carotid angioplasty and stenting may be an acceptable option in selected patients, much remains to be done to identify patients who benefit more from it than from carotid endarterectomy.
在颈动脉狭窄的治疗中，颈动脉血管成形术和支架置入术可能是颈动脉内膜切除术的替代方案，但它是否比颈动脉内膜切除术具有显著优势仍不明确。我们回顾了关于颈动脉狭窄患者行颈动脉血管成形术和支架置入术的证据。
对于手术风险未增加的有症状颈动脉狭窄患者，颈动脉血管成形术和支架置入术既不安全，短期结局也未改善。对于适合颈动脉内膜切除术的无症状颈动脉狭窄患者，该手术方式尚未得到充分评估。手术风险被认为较高的患者可能是颈动脉血管成形术和支架置入术的合适人选，但高风险的定义存在差异，且该手术方式仅在一项小型随机试验中与颈动脉内膜切除术进行了比较。许多登记研究表明，颈动脉血管成形术和支架置入术与颈动脉内膜切除术一样安全，但这些患者是否真的能从任何颈动脉血运重建策略中获益尚不确定。
对于适合颈动脉内膜切除术的颈动脉狭窄患者，颈动脉内膜切除术仍是“金标准”。虽然颈动脉血管成形术和支架置入术在特定患者中可能是可接受的选择，但要确定哪些患者从该手术中比从颈动脉内膜切除术中获益更多，仍有许多工作要做。
