Mackey William C
Department of Surgery, Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02111, USA.
Perspect Vasc Surg Endovasc Ther. 2010 Mar;22(1):7-15. doi: 10.1177/1531003510381135.
The goal of carotid disease management is prevention of stroke. Many randomized prospective trials of carotid disease management provide level-1 evidence to guide decision making to optimize stroke prevention in patients with carotid disease. Other patients present with clinical scenarios that fall outside the eligibility criteria for these clinical trials, and in these patients, clinical decisions must be based on the best available information on the natural history of each patient's carotid disease and on the clinician's assessment of the risks and benefits of intervention. In this monograph, the author reviews the current clinical data relating to carotid revascularization for asymptomatic carotid disease, for carotid disease with transient ischemic attack or minor stroke, and for carotid disease with acute stroke or stroke in evolution. Relevant clinical trials of carotid endarterectomy and carotid stenting are reviewed in detail. In addition, relevant natural history and risk-benefit data are reviewed to guide clinical decision making in patients whose clinical presentations fall outside the scope of the available clinical trials. The goal of this monograph is to provide the clinician with an evidence basis for clinical decision making in patients with commonly encountered carotid disease-related presentations.
颈动脉疾病管理的目标是预防中风。许多关于颈动脉疾病管理的随机前瞻性试验提供了一级证据，以指导决策，优化颈动脉疾病患者的中风预防。其他患者的临床情况不符合这些临床试验的纳入标准，对于这些患者，临床决策必须基于关于每位患者颈动脉疾病自然史的最佳可用信息以及临床医生对干预风险和益处的评估。在这本专著中，作者回顾了与无症状颈动脉疾病、伴有短暂性脑缺血发作或轻度中风的颈动脉疾病以及伴有急性中风或进展性中风的颈动脉疾病的颈动脉血运重建相关的当前临床数据。详细回顾了颈动脉内膜切除术和颈动脉支架置入术的相关临床试验。此外，还回顾了相关的自然史和风险效益数据，以指导临床表现超出可用临床试验范围的患者的临床决策。这本专著的目标是为临床医生提供证据基础，以便对常见的颈动脉疾病相关临床表现患者进行临床决策。
