Department of Neurology, Betty Cowan Research and Innovation Centre, Christian Medical College, Ludhiana, Punjab, India.
Neurol India. 2011 May-Jun;59(3):376-82. doi: 10.4103/0028-3886.82741.
Carotid stenosis is seen in 10% of patients with ischemic stroke, and carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the two invasive treatments options available. Pooled analysis of the three largest randomized trials of CEA involving more than 3000 symptomatic patients estimated 30-day stroke and death rate at 7.1% after CEA. Some subgroups among the symptomatic patients appeared to have more benefit from CEA. These include patients aged 75 years or more, patients with ulcerated plaques, and patients with recent transient ischemic attacks within 2 weeks of randomization. Selection of asymptomatic patients for carotid revascularization should be guided by an assessment of comorbid conditions, life expectancy, and other individual factors, and should include a thorough discussion of the risks and benefits of the procedure with an understanding of patient preferences. The recent trials comparing CEA with CAS has not established its superiority over CEA. The carotid revascularization endarterectomy versus stenting (CREST) study showed that CAS is still associated with a higher periprocedural risk of stroke or death than CEA. In patients over 70 years of age, CEA is clearly superior to CAS. The increased risk of nonfatal myocardial infarction in the CREST group subjected to CEA clearly suggests that patients being considered for CEA or CAS require a careful preliminary cardiac evaluation. CAS can be justified for patients whose medical comorbidities or cervical anatomy make them questionable candidates for CEA. The benefit of revascularization by either method versus modern aggressive medical therapy has not been established for patients with asymptomatic carotid stenosis.
颈动脉狭窄在缺血性脑卒中患者中占 10%，颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）是两种可供选择的有创治疗方法。对涉及 3000 多名症状性患者的三项最大的 CEA 随机试验进行的汇总分析估计，CEA 后 30 天的卒中发生率和死亡率为 7.1%。症状性患者中的一些亚组似乎从 CEA 中获益更多。这些亚组包括年龄在 75 岁或以上的患者、有溃疡斑块的患者以及在随机分组后 2 周内发生短暂性脑缺血发作的患者。无症状患者进行颈动脉血运重建的选择应根据合并症、预期寿命和其他个体因素进行评估，并应在了解患者偏好的情况下，对该手术的风险和获益进行充分讨论。最近比较 CEA 与 CAS 的试验并未证实 CAS 优于 CEA。颈动脉血运重建内膜切除术与支架置入术（CREST）研究表明，CAS 与 CEA 相比，围手术期卒中或死亡的风险仍然更高。在 70 岁以上的患者中，CEA 明显优于 CAS。接受 CEA 的 CREST 组中非致命性心肌梗死的风险增加清楚地表明，考虑接受 CEA 或 CAS 的患者需要进行仔细的初步心脏评估。对于因合并症或颈椎解剖结构而使 CEA 成为可疑候选者的患者，CAS 是合理的。对于无症状性颈动脉狭窄患者，通过任何一种方法进行血运重建与现代积极的药物治疗相比是否有益尚未确定。
