Lam Russell C
Medical Director of Endovascular Surgery, Presbyterian Hospital of Dallas, 8220 Walnut Hill Lane, Prof. Bldg. II, Suite 616, Dallas, TX, 75231, USA.
J Invasive Cardiol. 2009 Aug;21(8):413-4.
Stroke is the third most common cause of death in the United States. Approximately 30% of all ischemic strokes are secondary to carotid artery disease. Carotid endarterectomy (CEA) is considered the gold standard for the treatment of carotid artery stenosis. Endovascular techniques such as carotid angioplasty and stenting (CAS) have been proposed as possible alternatives for high-risk patients, but not until the advent of embolic protection devices (EPD) were they considered an acceptable alternative to surgery. There are currently two types of cerebral protection strategies employed: distal protection in the form of an occlusion balloon or filter, and proximal protection in the form of flow interruption or reversal devices. Advantages and disadvantages of each type will be reviewed. The selection of an EPD largely depends on anatomy as well as operator preference. Although there is currently a lack of consensus among interventionists performing CAS on the optimal EPD, all have agreed that routine use of an EPD during CAS is beneficial and mandatory.
中风是美国第三大常见死因。所有缺血性中风中约30%继发于颈动脉疾病。颈动脉内膜切除术（CEA）被认为是治疗颈动脉狭窄的金标准。血管内技术，如颈动脉血管成形术和支架置入术（CAS），已被提议作为高危患者的可能替代方案，但直到栓子保护装置（EPD）出现，它们才被认为是手术的可接受替代方案。目前采用两种类型的脑保护策略：以闭塞球囊或过滤器形式的远端保护，以及以血流中断或逆转装置形式的近端保护。将对每种类型的优缺点进行综述。EPD的选择很大程度上取决于解剖结构以及术者偏好。尽管目前在进行CAS的介入医生中，对于最佳EPD缺乏共识，但所有人都同意在CAS期间常规使用EPD是有益的且是必需的。
