Jim Jeffrey, Sicard Gregorio A
Washington University School of Medicine, St Louis, MO 63110, USA.
Perspect Vasc Surg Endovasc Ther. 2010 Mar;22(1):40-6. doi: 10.1177/1531003510379879.
Carotid endarterectomy (CEA) has long been considered the "gold standard" in the treatment of patients with symptomatic or asymptomatic carotid stenosis. However, the utility of this treatment modality in medical or surgical "high-risk" patients remains in question. Numerous clinical trials have demonstrated that carotid angioplasty and stenting (CAS) is not inferior to CEA. Furthermore, there are also increasing data that show that best medical therapy is becoming more effective in preventing strokes and in a more cost-effective manner than carotid interventions. With this in mind, there is now ample evidence to suggest that in a certain subgroup of patients, CEA may not be indicated, and in fact, CAS or observation with best medical therapy is preferred.
长期以来，颈动脉内膜切除术（CEA）一直被视为治疗有症状或无症状颈动脉狭窄患者的“金标准”。然而，这种治疗方式在医学或手术“高危”患者中的效用仍存在疑问。众多临床试验表明，颈动脉血管成形术和支架置入术（CAS）并不逊色于CEA。此外，越来越多的数据显示，最佳药物治疗在预防中风方面正变得更加有效，且比颈动脉干预措施更具成本效益。考虑到这一点，现在有充分证据表明，在某些患者亚组中，可能不适合进行CEA，事实上，CAS或采用最佳药物治疗进行观察更为可取。
