Interventional Cardiology Unit, Division of Cardiology, University Hospital, Geneva, Switzerland.
Curr Cardiol Rep. 2012 Apr;14(2):125-34. doi: 10.1007/s11886-012-0246-1.
Patients with severe carotid and coronary disease-especially if they require coronary artery bypass grafting (CABG)-are at high risk of cardiac events and stroke. Carotid revascularization should be considered for patients with symptomatic carotid disease and bilateral severe asymptomatic carotid stenosis. In patients with unilateral asymptomatic carotid stenosis, decision to proceed to revascularization should be based more on a perspective of long-term stroke prevention than of perioperative stroke reduction. Compared with endarterectomy, carotid artery stenting is associated with a lower incidence of periprocedural myocardial infarction, an event linked to long-term mortality. This observation may be particularly relevant for patients with advanced coronary artery disease such as those undergoing CABG. Irrespective of the carotid revascularization strategy, a broad disease management approach based on lifestyle modification and pharmacologic cardiovascular prevention is more likely to affect both the quality and duration of life than revascularization itself.
患有严重颈动脉和冠状动脉疾病的患者（尤其是需要冠状动脉旁路移植术（CABG）的患者）发生心脏事件和中风的风险很高。对于有症状性颈动脉疾病和双侧严重无症状性颈动脉狭窄的患者，应考虑进行颈动脉血运重建。对于单侧无症状性颈动脉狭窄的患者，决定进行血运重建应更多地基于长期预防中风的角度，而不是减少围手术期中风的角度。与颈动脉内膜切除术相比，颈动脉支架置入术与围手术期心肌梗死的发生率较低相关，而该事件与长期死亡率相关。对于正在接受 CABG 等冠状动脉疾病进展的患者，这种观察结果可能更为重要。无论采用哪种颈动脉血运重建策略，基于生活方式改变和药物心血管预防的广泛疾病管理方法都更有可能影响生活质量和寿命，而不仅仅是血运重建本身。
