J Med Imaging Radiat Oncol. 2009 Dec;53(6):538-45. doi: 10.1111/j.1754-9485.2009.02120.x.
The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy (CEA) remains the benchmark in terms of procedural mortality and morbidity. Consensus Australasian guidelines for the safe performance of CAS were developed using the modified Delphi consensus method of iterative consultation. Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria. Randomised controlled trials and pooled analyses have demonstrated that CAS is more hazardous than CEA. The CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. There is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomised controlled trials, carotid and aortic arch anatomy and pathology, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuroimaging and peri-procedural, independent, neurological assessment. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programmes. These standards should apply in the public and private health-care settings. These guidelines represent the consensus of an intercollegiate committee in order to direct appropriate patient selection to perform CAS. Advances in endovascular technologies and the results of randomised controlled trials will guide future revisions of this document.
采用颈动脉支架置入术（CAS）对颈动脉粥样硬化进行血管内治疗仍存在争议。就手术死亡率和发病率而言，颈动脉内膜切除术（CEA）仍是基准。澳大利亚关于安全实施CAS的共识指南是采用改良的德尔菲共识方法通过反复协商制定的。选择适合CAS的患者需要仔细考虑临床和病理解剖学标准。随机对照试验和汇总分析表明，CAS比CEA更具危险性。因此，澳大利亚血管外科学会（CGSC）建议，大多数需要进行颈动脉血运重建的患者不应接受CAS治疗。目前尚无证据支持将CAS作为无症状性颈动脉狭窄的治疗方法。在CAS过程中使用远端保护装置仍存在争议，因为临床无症状性卒中的风险增加。安全实施CAS所需的知识包括对随机对照试验的证据基础、颈动脉和主动脉弓解剖学及病理学的理解，以及围手术期并发症的识别和管理。至关重要的是，所有考虑接受颈动脉干预的患者都应进行充分的术前神经影像学检查和围手术期独立的神经学评估。维持CAS的熟练程度需要积极参与手术/血管内审计和继续医学教育项目。这些标准应适用于公立和私立医疗保健机构。这些指南代表了一个跨学院委员会的共识，以便指导进行CAS的合适患者选择。血管内技术的进步和随机对照试验的结果将指导本文件的未来修订。
