Setacci C, de Donato G, Setacci F, Sirignano P, Galzerano G, Borrelli M P, Cappelli A
Unit of Vascular and Endovascular Surgery, Department of Surgery, University of Siena, Siena, Italy.
J Cardiovasc Surg (Torino). 2013 Feb;54(1):61-6.
Treatment of acute stroke is time-dependent, with the best outcomes resulting from the earliest interventions. However, for patients with acute ischemic stroke due to a high-grade stenosis of the internal carotid artery, despite maximal medical treatment, an effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established. There are two major concerns: first, cerebral revascularization in the acute stage remains challenging because of the possibility that hemorrhagic infarction or hyperperfusion syndrome will occur after revascularization; second, alarms about carotid artery stenting in patients with acute symptoms are related to the fact that, while with carotid endarterectomy the plaque is completely removed, after stenting it is only remodelled and its stabilization is essential to avoid embolic events during the procedure and in the post-operative period. Although level 1 evidence seems clearly in favor of carotid endarterectomy in symptomatic patients, carotid stenting has been proposed as a possible alternative in selected cases if the procedure is performed in high-volume center with documented low perioperative stroke and death rates. This review summarizes indications and results for carotid artery stenting in recently symptomatic patients.
急性中风的治疗具有时间依赖性，最早进行干预可获得最佳疗效。然而，对于因颈内动脉高度狭窄导致急性缺血性中风的患者，尽管进行了最大程度的药物治疗，但尚未确立改善其神经症状和临床结局的有效干预措施。存在两个主要问题：第一，急性期中的脑血运重建仍然具有挑战性，因为血运重建后可能会发生出血性梗死或高灌注综合征；第二，对有急性症状患者进行颈动脉支架置入术的担忧与以下事实有关，即颈动脉内膜切除术可完全清除斑块，而支架置入术后斑块仅得到重塑，其稳定性对于避免手术过程中和术后发生栓塞事件至关重要。尽管一级证据似乎明确支持对有症状患者进行颈动脉内膜切除术，但如果在具有低围手术期中风和死亡率记录的高容量中心进行该手术，颈动脉支架置入术已被提议作为特定病例的一种可能替代方案。本综述总结了近期有症状患者颈动脉支架置入术的适应证和结果。
