Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
World Neurosurg. 2011 Dec;76(6 Suppl):S40-59. doi: 10.1016/j.wneu.2011.06.019.
Carotid artery disease is a major cause of the disability and mortality associated with strokes. Ischemic stroke remains the major cause of adult disability and third-leading cause of adult mortality, and carotid revascularization currently remains the principal surgical tool in the prophylaxis of this disease.
The literature representing the current body of evidence for carotid revascularization and the authors' current practices in the management of this disease are summarized in this review.
We provide an evidence-based narration of the development and current status of carotid artery stenting (CAS) by reviewing 1) the evidence for carotid revascularization from early carotid endarterectomy (CEA) trials; 2) the randomized trials comparing CEA and CAS, with a special emphasis on the recently published results of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which have been a "game-changer," tipping the balance towards accepting CAS as a safe, equally effective, and durable alternative to CEA for all patients requiring carotid revascularization; and 3) the technical advances in CAS after enrollment of patients in the CREST.
CAS and CEA are complementary procedures. Judicious selection of the procedure is made on a case-by-case basis.
颈动脉疾病是导致中风相关残疾和死亡的主要原因。缺血性中风仍然是导致成人残疾的主要原因，也是成人死亡的第三大原因，颈动脉血运重建术目前仍然是预防这种疾病的主要手术手段。
本综述总结了目前颈动脉血运重建术的证据和作者在治疗这种疾病方面的当前实践。
通过回顾 1）早期颈动脉内膜切除术（CEA）试验中颈动脉血运重建的证据；2）比较 CEA 和 CAS 的随机试验，特别强调最近发表的颈动脉血运重建内膜切除术与支架置入术试验（CREST）的结果，我们提供了颈动脉支架置入术（CAS）的循证叙述，这一试验结果改变了局面，使 CAS 作为所有需要颈动脉血运重建的患者的一种安全、同样有效和持久的 CEA 替代方法被接受；3）在 CREST 试验纳入患者后，CAS 的技术进展。
CAS 和 CEA 是互补的程序。应根据具体情况明智地选择手术。
