Hertzer Norman R
Department of Vascular Surgery, Cleveland Clinic Emeritus Office 3050 Science Park Drive (AC334), Beachwood, OH 44122 USA.
F1000 Med Rep. 2010 Dec 17;2:91. doi: 10.3410/M2-91.
Several large randomized clinical trials in North America and Europe concluded over a decade ago that carotid endarterectomy plus medical management was significantly better than medical management alone for stroke prevention in either symptomatic or asymptomatic patients with severe carotid stenosis. Percutaneous carotid angioplasty now represents yet another treatment option that currently appears to have a higher risk than endarterectomy in symptomatic patients as well as in those who are 70 years of age or older. For these reasons, there is a consensus that angioplasty should be used cautiously in such patients and probably remains most appropriate either in the context of ongoing randomized trials or for patients who are at a higher-than-average risk for conventional surgical treatment.
十多年前，北美和欧洲的几项大型随机临床试验得出结论，对于有症状或无症状的严重颈动脉狭窄患者，颈动脉内膜切除术加药物治疗在预防中风方面明显优于单纯药物治疗。经皮颈动脉血管成形术现在是另一种治疗选择，目前在有症状的患者以及70岁及以上的患者中，其风险似乎高于内膜切除术。出于这些原因，人们达成共识，在这类患者中应谨慎使用血管成形术，并且在正在进行的随机试验背景下或对于传统手术治疗风险高于平均水平的患者，血管成形术可能仍然是最合适的。
