De Borst G J, Schermerhorn M, Moll F L
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
J Cardiovasc Surg (Torino). 2015 Apr;56(2):145-52. Epub 2015 Jan 23.
Carotid artery revascularization by endarterectomy is an effective means of stroke prevention in selected patients with carotid stenosis. With the development of endovascular techniques, carotid artery stenting (CAS) has been proposed as a viable alternative to carotid endarterectomy (CEA), particularly in patients considered at high risk for CEA. Guidelines have established criteria that outline these patients who are considered at "high risk" for complications after CEA, to whom CAS may provide benefit. The validity of these theoretical high-risk criteria, however, is yet unproven, and, as a consequence, there is no clear evidence suggesting that the risk with CAS is lower in these high-risk patients compared with CEA. This manuscript summarizes the role of "high risk" within recent trials and discusses why the optimal treatment for these patients with deemed high risk for surgery remains a matter of debate.
通过内膜切除术进行颈动脉血运重建是特定颈动脉狭窄患者预防中风的有效手段。随着血管内技术的发展，颈动脉支架置入术（CAS）已被提议作为颈动脉内膜切除术（CEA）的一种可行替代方法，尤其是在被认为接受CEA手术风险较高的患者中。指南已经制定了标准，概述了这些被认为在CEA术后出现并发症“高风险”的患者，CAS可能对他们有益。然而，这些理论上的高风险标准的有效性尚未得到证实，因此，没有明确证据表明在这些高风险患者中，CAS的风险低于CEA。本文总结了“高风险”在近期试验中的作用，并讨论了为什么对于这些被认为手术风险高的患者，最佳治疗方法仍存在争议。
