Department of Vascular and Endovascular Surgery, Verbundkrankenhaus Bernkastel/Wittlich, Koblenzerstr 91, 54516 Wittlich, Germany.
Eur J Vasc Endovasc Surg. 2011 Apr;41(4):501-6. doi: 10.1016/j.ejvs.2010.12.006. Epub 2011 Feb 3.
The optimal treatment of asymptomatic carotid disease is being debated again. The conclusions of the large randomised controlled trials of the early 1980s and 1990s are increasingly being questioned due to advances in modern medical treatment. This study investigates how patients are actually managed medically related to general risk factors prior to carotid endarterectomy in a German health-care region.
MATERIALS/METHODS: A prospective data bank including 95 consecutive patients was used. The effectiveness of lipid lowering and diabetes management were investigated as well as the use of anti-thrombotic and blood pressure medication.
A total of 108 carotid endarterectomies in 95 patients were performed between January 2009 and March 2010. All 95 patients (70 male, 25 female; 39 symptomatic/56 asymptomatic) were included in the study. Nearly half (54%) of the patients were on statins; of these, 45% had low-density lipoprotein (LDL) levels >100 mg dl(-1). Of 32 patients with diabetes, one had glycohaemoglobin (HbA(1c)) <6.0. Overall, four patients were on clopidogrel. Three patients were severely hypertensive (systolic blood pressure >180 mmHg).
The best medical therapy for carotid disease is not optimal in the part of the German health-care system observed in this study. We strongly advocate similar audits in other health-care areas and systems.
无症状颈动脉疾病的最佳治疗方法再次引起争议。由于现代医学的进步，20 世纪 80 年代和 90 年代大型随机对照试验的结论越来越受到质疑。本研究调查了在德国医疗保健区域，在颈动脉内膜切除术之前，与一般危险因素相关的无症状颈动脉疾病患者的实际医学治疗方法。
材料/方法：使用了一个包含 95 例连续患者的前瞻性数据库。研究了降脂和糖尿病管理的效果，以及抗血栓和血压药物的使用。
2009 年 1 月至 2010 年 3 月期间，共对 95 例患者的 108 例颈动脉内膜切除术进行了研究。所有 95 例患者（70 例男性，25 例女性；39 例有症状/56 例无症状）均纳入本研究。近一半（54%）的患者服用他汀类药物；其中 45%的患者低密度脂蛋白（LDL）水平>100mg/dl。32 例糖尿病患者中，仅 1 例糖化血红蛋白（HbA1c）<6.0。总的来说，有 4 例患者服用氯吡格雷。有 3 例患者血压严重升高（收缩压>180mmHg）。
在本研究观察的德国医疗保健系统中，颈动脉疾病的最佳药物治疗并不理想。我们强烈主张在其他医疗保健领域和系统中进行类似的审核。
