有症状患者中颈动脉支架置入术的适应证可能需要重新考虑。

The indications of carotid artery stenting in symptomatic patients may need to be reconsidered.

作者信息

Paraskevas Kosmas I, Veith Frank J

机构信息

Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK.

Division of Vascular Surgery, New York University Langone Medical Center, New York, NY; Division of Vascular Surgery, The Cleveland Clinic, Cleveland, OH.

出版信息

Ann Vasc Surg. 2015 Jan;29(1):154-9. doi: 10.1016/j.avsg.2014.08.010. Epub 2014 Oct 8.

DOI:10.1016/j.avsg.2014.08.010

PMID:25305422

Abstract

According to the 2011 and the 2014 updated American Heart Association/American Stroke Association Guidelines, carotid artery stenting (CAS) is indicated as an alternative to carotid endarterectomy (CEA) for the management of symptomatic carotid patients. According to these recommendations, CAS is preferred to CEA in symptomatic patients with specific technical, anatomic, or physiological characteristics that render these individuals at "high risk" for surgery (e.g., contralateral carotid occlusion, previous neck irradiation, recurrent carotid stenosis, and so forth). This article presents emerging data suggesting that most of these criteria do not comprise contraindications for CEA. In fact, CEA is associated with similar (or even better) outcomes compared with CAS in many such "high-risk" patients. Based on these results, the indications of CAS in symptomatic patients may need to be reconsidered.

摘要

根据2011年及2014年更新的美国心脏协会/美国中风协会指南，对于有症状的颈动脉疾病患者，颈动脉支架置入术（CAS）被视为颈动脉内膜切除术（CEA）的替代治疗方法。根据这些建议，对于具有特定技术、解剖或生理特征而使手术“高风险”的有症状患者（例如，对侧颈动脉闭塞、既往颈部放疗、复发性颈动脉狭窄等），CAS优于CEA。本文提供的新数据表明，这些标准大多并不构成CEA的禁忌证。事实上，在许多此类“高风险”患者中，CEA与CAS相比，其结局相似（甚至更好）。基于这些结果，有症状患者中CAS的适应证可能需要重新考虑。