Newark Hospital, Newark, UK.
Stroke. 2011 Jan;42(1):217-20. doi: 10.1161/STROKEAHA.110.600064. Epub 2010 Nov 24.
Carotid intervention in severe carotid stenosis after an anterior circulation ischemic event reduces the risk of further infarcts if the surgery is performed soon after the incident event. At present, there is no recommendation to differentiate among subtypes of anterior circulation infarcts or transient ischemic events. However, evidence is mounting that demonstrates a difference in pathophysiology of lacunar and nonlacunar (large artery) infarcts. The natural history of lacunar strokes is different from large artery infarcts for recurrence and mortality. Stroke is a heterogenous disease and consideration needs to be directed to manage different stroke subtypes differently. Lacunar infarcts mostly do not arise from large artery atheromatous disease or by cardioembolic phenomena, and there is a negative predictive value for severe carotid stenosis in lacunar strokes. Thus, current evidence suggests that lacunar strokes may not warrant investigation for carotid stenosis.
严重颈动脉狭窄患者在前循环缺血性事件后进行颈动脉干预，如果在事件发生后不久进行手术，可以降低进一步梗死的风险。目前，尚无建议对前循环梗死或短暂性脑缺血发作的亚型进行区分。然而，越来越多的证据表明腔隙性和非腔隙性（大动脉）梗死的病理生理学存在差异。腔隙性卒中的自然病程与大动脉梗死的复发和死亡率不同。卒中是一种异质性疾病，需要考虑对不同的卒中亚型进行不同的管理。腔隙性梗死主要不是由大动脉粥样硬化性疾病或心源性栓塞现象引起的，腔隙性卒中严重颈动脉狭窄的阴性预测值较高。因此，目前的证据表明腔隙性卒中可能不需要进行颈动脉狭窄检查。
