Boeckh-Behrens T, Brückmann H
Abteilung für Neuroradiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, München, Deutschland.
Radiologe. 2008 Nov;48(11):1047-54. doi: 10.1007/s00117-008-1710-1.
For symptomatic stenosis of the carotid artery the invasive options for treatment (by means of stent or operation) are superior to conservative medical treatment. Recent multi-center randomized controlled trials, which will be presented here, indicate that stenting in the treatment of symptomatic carotid stenosis is neither safer nor more effective than carotid endarterectomy. When carried out by an experienced interventionalist stent-assisted angioplasty (CAS) is an alternative to carotid endarterectomy. Subgroup-analysis indicates that for patients older than 70 years of age invasive techniques should be the method of choice. In the case of contralateral high-grade stenosis or occlusion, CAS is the method of choice. For patients treated by stenting, the periprocedural complication rate is not influenced by the use of protection systems. The present results on symptomatic carotid stenosis should not be transferred to the therapy of asymptomatic carotid stenosis. A 3-armed study (SPACE2) on the comparison of the best medical treatment with the invasive treatment modalities (CAS or CEA) is in preparation and will be started in 2 months.
对于有症状的颈动脉狭窄，侵入性治疗选择（通过支架或手术）优于保守药物治疗。本文将展示的近期多中心随机对照试验表明，在治疗有症状的颈动脉狭窄方面，支架置入术并不比颈动脉内膜切除术更安全或更有效。由经验丰富的介入专家进行时，支架辅助血管成形术（CAS）是颈动脉内膜切除术的一种替代方法。亚组分析表明，对于70岁以上的患者，侵入性技术应作为首选方法。在对侧存在高度狭窄或闭塞的情况下，CAS是首选方法。对于接受支架置入术治疗的患者，围手术期并发症发生率不受保护系统使用的影响。目前关于有症状颈动脉狭窄的结果不应推广到无症状颈动脉狭窄的治疗中。一项比较最佳药物治疗与侵入性治疗方式（CAS或CEA）的三臂研究（SPACE2）正在筹备中，将于两个月后启动。
