Kiernan Thomas J, Yan Bryan P, Jaff Michael R
Section of Vascular Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Mass 02114, USA.
J Vasc Surg. 2009 Aug;50(2):431-9. doi: 10.1016/j.jvs.2009.04.052.
Cerebrovascular disease is a leading cause of morbidity and mortality in developed countries around the world. In the United States, there are an estimated 700,000 cases of stroke annually (of which over 85% are ischemic), costing an estimated $56.8 billion in associated treatment. Large vessel internal carotid artery stenosis is an important cause of ischemic stroke. Population-based studies have shown that the prevalence of carotid stenosis is approximately 0.5% in the sixth decade of life and increases to approximately 10% in the ninth decade. The majority of patients are asymptomatic. Asymptomatic carotid stenosis with <or=75% lumen loss carries a stroke risk of 1.3% annually, whereas the combined risk of myocardial ischemia and vascular death is as high as 10%. With diameter stenosis >75%, the combined stroke and transient ischemic attack risk increases to approximately 11% annually, with 75% of events ipsilateral to the affected artery. Other studies have also shown that the risk of stroke increases proportionately to the severity of stenosis. The risk is higher for those patients who are symptomatic. In this review, we will discuss antiplatelet agents to prevent cerebrovascular events in the context of extracranial carotid artery disease. It is beyond the scope of this article to discuss antiplatelet treatment for other etiologies of stroke.
脑血管疾病是全球发达国家发病和死亡的主要原因。在美国，每年估计有70万例中风病例（其中超过85%为缺血性中风），相关治疗费用估计为568亿美元。大血管颈内动脉狭窄是缺血性中风的重要原因。基于人群的研究表明，颈动脉狭窄的患病率在60岁时约为0.5%，在90岁时增至约10%。大多数患者无症状。管腔损失≤75%的无症状颈动脉狭窄患者每年的中风风险为1.3%，而心肌缺血和血管性死亡的综合风险高达10%。当直径狭窄>75%时，中风和短暂性脑缺血发作的综合风险每年增至约11%，其中75%的事件发生在患侧动脉同侧。其他研究也表明，中风风险与狭窄严重程度成正比。有症状的患者风险更高。在本综述中，我们将讨论在颅外颈动脉疾病背景下预防脑血管事件的抗血小板药物。本文不讨论针对其他中风病因的抗血小板治疗。
