Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, 1 Rimini street, Haidari, Athens 12462, Greece.
Eur J Vasc Endovasc Surg. 2012 Sep;44(3):238-43. doi: 10.1016/j.ejvs.2012.04.015. Epub 2012 Jun 1.
Many medical societies now recommend carotid stenting as an alternative to endarterectomy which raises the question of whether the ESVS guidelines are still valid. This review addresses the validity of the ESVS guidelines that refer to carotid stenting based on the evidence available today.
We conducted a review and meta-analysis based on the original ESVS guidelines paper and articles published over the past 2 years.
For symptomatic patients, surgery remains the best option, since stenting is associated with a 61% relative risk increase of periprocedural stroke or death compared to endarterectomy. However, centres of excellence in carotid stenting may achieve comparable results. In asymptomatic patients, there is still no good evidence for any intervention because the stroke risk from an asymptomatic stenosis is very low, especially with the best modern medical treatment. CREST and CAVATAS have verified that mid-term stroke prevention after successful stenting is similar to endarterectomy. EVA-3S, SPACE, ICSS and CREST have provided additional evidence regarding the role of age in choosing therapeutic modality. The role of the cerebral protection devices is challenged by the imaging findings of small randomised trials but supported by large systematic reviews.
The ESVS guidelines that refer to carotid stenting not only remain valid but also have been further strengthened by the latest available clinical data. An update of these guidelines including all of the recent evidence is needed to provide an objective and up-to-date interpretation of the data.
目前许多医学协会建议将颈动脉支架置入术作为动脉内膜切除术的替代方法，这就提出了 ESVS 指南是否仍然有效的问题。本综述针对目前可获得的证据，探讨了与颈动脉支架置入术相关的 ESVS 指南的有效性。
我们基于原始 ESVS 指南论文和过去 2 年发表的文章进行了综述和荟萃分析。
对于有症状的患者，手术仍然是最佳选择，因为与颈动脉内膜切除术相比，支架置入术与围手术期卒中或死亡的相对风险增加 61%相关。然而，颈动脉支架置入术的卓越中心可能会取得类似的结果。对于无症状患者，目前仍然缺乏任何干预措施的良好证据，因为无症状狭窄导致卒中的风险非常低，尤其是在接受最佳现代医学治疗的情况下。CREST 和 CAVATAS 已证实，成功支架置入后的中期卒中预防与颈动脉内膜切除术相似。EVA-3S、SPACE、ICSS 和 CREST 提供了更多关于年龄在选择治疗方式中的作用的证据。小型随机试验的影像学结果对脑保护装置的作用提出了挑战，但大型系统评价支持了该作用。
与颈动脉支架置入术相关的 ESVS 指南不仅仍然有效，而且还通过最新的临床数据得到了进一步加强。需要更新这些指南，纳入所有最新证据，以客观、及时地解释这些数据。
