Macdonald S
Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, UK.
J Cardiovasc Surg (Torino). 2012 Feb;53(1 Suppl 1):23-6.
Carotid stenting in standard risk patients has recently received supportive recommendations from the American Heart Association, in a guideline document endorsed by 14 societies with diverse but vested interest in carotid intervention. The procedural hazard i.e. the composite endpoint: all-stroke/death/myocardial infarction (MI) for carotid stenting and endarterectomy are equivalent, as is survival free of ipsilateral stroke for the two interventional strategies. However, the microembolic burden generated by endarterectomy and stenting is discrepant and although the fate and clinical relevance of diffusion-weighted magnetic resonance imaging new white lesions and of microembolic signals on transcranial Doppler remain disputed, empathic reasoning would suggest that technical and/or procedural modifications should be explored and employed during carotid stenting in order to try addressing microemboli. This article seeks to define those procedural steps likely to be associated with microemboli during carotid stenting and thus provide avoidance manoeuvres and/or possible solutions.
近期，在一份由14个对颈动脉介入有着不同但既定利益的学会认可的指南文件中，美国心脏协会对标准风险患者的颈动脉支架置入术给出了支持性建议。手术风险，即综合终点：颈动脉支架置入术和内膜切除术的全卒中/死亡/心肌梗死（MI）发生率相当，两种介入策略在无同侧卒中生存方面也是如此。然而，内膜切除术和支架置入术产生的微栓塞负荷存在差异，尽管弥散加权磁共振成像新出现的白色病变以及经颅多普勒微栓塞信号的转归和临床相关性仍存在争议，但凭经验推断，在颈动脉支架置入术中应探索并采用技术和/或手术改进措施，以尝试解决微栓塞问题。本文旨在确定颈动脉支架置入术中可能与微栓塞相关的那些手术步骤，从而提供避免措施和/或可能的解决方案。
