Shallwani Hussain, Dumont Travis M, Wach Michael M, Levy Elad I, Siddiqui Adnan H
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
J Vasc Interv Neurol. 2014 May;7(1):43-6.
Medical treatment of low-grade (<50% luminal narrowing) symptomatic carotid stenosis has been the treatment of choice because trial data showed no evident benefit to carotid endarterectomy for these patients. Such patients may have recurrent neurological symptoms despite adequate medical therapy owing to recurrent plaque rupture. In such cases, carotid stenting may represent an option for treatment but has not been tested in trials because of previous failure of carotid endarterectomy to demonstrate any benefit for patients with low-grade carotid stenosis. The cases presented here illustrate the perioperative safety and potential benefit of carotid stenting for such patients with persistent neurological symptoms despite adequate medical therapy.
Two patients with low-grade stenosis and recurrent transient ischemic attack or stroke despite antiplatelet therapy were treated with carotid stenting. Both patients were treated after recent ipsilateral neurological events in the absence of an evident cardioembolic source. Carotid plaque ulceration thought to be related to the ischemic events was present in both cases. No perioperative complications were noted. On followup, the patients showed resolution of symptoms and had no new neurological events.
Carotid stenting of low-grade but symptomatic carotid plaque refractory to medical management represents a surgical option for treatment. Further studies may be warranted to evaluate stenting as a suitable treatment option.
对于症状性轻度（管腔狭窄<50%）颈动脉狭窄，药物治疗一直是首选治疗方法，因为试验数据表明，对于这些患者，颈动脉内膜切除术并无明显益处。尽管进行了充分的药物治疗，但由于斑块反复破裂，此类患者仍可能出现复发性神经症状。在这种情况下，颈动脉支架置入术可能是一种治疗选择，但由于此前颈动脉内膜切除术未能证明对轻度颈动脉狭窄患者有任何益处，因此尚未在试验中得到验证。本文介绍的病例说明了对于尽管接受了充分药物治疗但仍有持续性神经症状的此类患者，颈动脉支架置入术的围手术期安全性和潜在益处。
两名轻度狭窄患者，尽管接受了抗血小板治疗，仍反复出现短暂性脑缺血发作或中风，接受了颈动脉支架置入术治疗。两名患者均在近期同侧发生神经事件后接受治疗，且无明显的心源性栓塞源。两例均存在被认为与缺血事件相关的颈动脉斑块溃疡。未观察到围手术期并发症。随访时，患者症状消失，未出现新的神经事件。
对于药物治疗无效的轻度但有症状的颈动脉斑块，颈动脉支架置入术是一种手术治疗选择。可能需要进一步研究以评估支架置入术是否为合适的治疗选择。
