Chaturvedi Seemant, Bhattacharya Pratik
Continuum (Minneap Minn). 2014 Apr;20(2 Cerebrovascular Disease):323-34. doi: 10.1212/01.CON.0000446104.90043.a5.
Large artery atherosclerosis is an important cause of ischemic stroke. Recent randomized clinical trials have helped clarify the treatment options for conditions such as carotid stenosis and intracranial atherosclerosis. This review outlines the primary findings of these trials and provides current recommendations for treatment.
Carotid revascularization is preferred in patients with severe symptomatic carotid stenosis. Carotid endarterectomy achieves lower rates of stroke or death than carotid artery stenting. The risk of stroke or death with stenting is higher among older patients and women. Intensive medical therapy achieves low stroke and death rates in asymptomatic stenosis. Medical therapy and treatment of atherosclerotic risk factors are the mainstay of therapy for intracranial atherosclerosis, and medical therapy is recommended for patients with vertebral artery origin atherosclerosis.
Contemporary medical therapy is paramount in large artery atherosclerosis. Patient demographics, comorbidities, and the periprocedural risks of stroke and death should be carefully weighed while choosing a revascularization procedure for carotid stenosis.
大动脉粥样硬化是缺血性卒中的重要病因。近期的随机临床试验有助于明确颈动脉狭窄和颅内动脉粥样硬化等疾病的治疗选择。本综述概述了这些试验的主要发现，并提供了当前的治疗建议。
对于有症状的重度颈动脉狭窄患者，颈动脉血运重建术是首选。颈动脉内膜切除术的卒中或死亡率低于颈动脉支架置入术。老年患者和女性接受支架置入术的卒中或死亡风险更高。强化药物治疗在无症状狭窄患者中可实现较低的卒中和死亡率。药物治疗和动脉粥样硬化危险因素的控制是颅内动脉粥样硬化治疗的主要手段，对于椎动脉起始部动脉粥样硬化患者，推荐药物治疗。
在大动脉粥样硬化中，当代药物治疗至关重要。在为颈动脉狭窄选择血运重建手术时，应仔细权衡患者的人口统计学特征、合并症以及围手术期的卒中和死亡风险。
