Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Fitkin Memorial Pavilion, 789 Howard Avenue 3rd floor, New Haven, CT, 06519, USA,
Curr Cardiol Rep. 2014 Mar;16(3):462. doi: 10.1007/s11886-013-0462-3.
Extracranial carotid artery stenosis accounts for up to 12 % of stroke, the third leading cause of death in industrialized nations. Carotid stenoses leading to transient or permanent neurologic or retinal symptoms within the preceding 6 months are deemed symptomatic and require prompt noninvasive evaluation and treatment. Preventive medical therapy is standard for symptomatic carotid stenosis and continues to evolve. Landmark trials have proven carotid endarterectomy (CEA) superior to medical therapy for stroke prevention in symptomatic lesions. Modern investigations have proven carotid artery stenting (CAS) non-inferior to CEA, and the strength of the combined data has led to a class I recommendation for CEA or CAS in patients with high grade symptomatic carotid stenosis, provided the risk of perioperative events is acceptable. Evidence-based modern management of symptomatic carotid stenosis is reviewed here.
颅外颈动脉狭窄占中风的 12%，是工业化国家的第三大致死原因。在过去 6 个月内导致短暂或永久性神经或视网膜症状的颈动脉狭窄被认为是症状性的，需要立即进行非侵入性评估和治疗。预防性药物治疗是症状性颈动脉狭窄的标准治疗方法，并且仍在不断发展。里程碑式的试验已经证明颈动脉内膜切除术 (CEA) 在预防症状性病变中的卒中方面优于药物治疗。现代研究已经证明颈动脉支架置入术 (CAS) 并不逊于 CEA，综合数据的强度导致了对高分级症状性颈动脉狭窄患者进行 CEA 或 CAS 的 I 类推荐，前提是围手术期事件的风险是可以接受的。这里回顾了基于证据的症状性颈动脉狭窄的现代管理。
