Rockman Caron, Riles Thomas
New York University Medical School, New York, NY 10016, USA.
Perspect Vasc Surg Endovasc Ther. 2010 Mar;22(1):30-7. doi: 10.1177/1531003510379881.
Despite randomized controlled trials demonstrating the superiority of carotid endarterectomy over medical management in the prevention of stroke in asymptomatic patients with severe carotid artery stenosis, considerable controversy remains with regard to selecting the appropriate asymptomatic patient for carotid intervention. Adding to the complexity of this issue is the fact that the extensive existing literature on this topic is heterogeneous, with trials having used varying definitions of high-grade stenosis, inclusion criteria for patients, and outcome measurements. The current article will review the existing randomized controlled trials on this topic, data regarding the risk of stroke in asymptomatic patients with severe stenosis, data regarding subsets of asymptomatic patients that may be at a higher-than-average risk of future stroke, and data regarding the efficacy of current medical therapy on the risk of stroke in asymptomatic patients with high-grade stenosis. Ultimately, the challenge for clinicians is to ensure that asymptomatic patients with the highest risk of future stroke are offered carotid revascularization and that the intervention is performed with the lowest possible complication rate, in order to maintain the benefit of prophylactic treatment.
尽管随机对照试验表明，在预防严重颈动脉狭窄无症状患者的中风方面，颈动脉内膜切除术优于药物治疗，但在选择合适的无症状患者进行颈动脉干预方面，仍存在相当大的争议。使这个问题更加复杂的是，关于这个主题的大量现有文献参差不齐，各试验对重度狭窄的定义、患者纳入标准以及结果测量方法各不相同。本文将回顾关于这个主题的现有随机对照试验、重度狭窄无症状患者中风风险的数据、可能比平均水平有更高未来中风风险的无症状患者亚组的数据，以及当前药物治疗对重度狭窄无症状患者中风风险疗效的数据。最终，临床医生面临的挑战是确保为未来中风风险最高的无症状患者提供颈动脉血运重建，并且以尽可能低的并发症发生率进行干预，以维持预防性治疗的益处。
