Davis S M, Gates P C
Neurology Unit, Royal Melbourne Hospital, Parkville, VIC.
Med J Aust. 1989 Jan 2;150(1):28-30. doi: 10.5694/j.1326-5377.1989.tb136316.x.
Carotid endarterectomy has been accepted widely as an important stroke-prevention tool since the 1950s, in spite of the lack of any proof of its efficacy in randomized, controlled clinical trials in either symptomatic or asymptomatic patients. While surgery for asymptomatic carotid disease always has been controversial, the indications and benefits of carotid endarterectomy in symptomatic patients now are being questioned also, although the available evidence suggests that the operation, when performed in expert hands, reduces the incidence of subsequent strokes in patients with minor, carotid-territorial ischaemic events and significant ipsilateral carotid disease. (A morbidity and mortality rate of more than 3% is unacceptable, and hence the procedure should be undertaken only by those who are skilled in its performance). For each patient, a decision has to be made as to whether the potential reduction of the risk of stroke outweighs the immediate surgical risk of stroke or death. Some large, expensive and important randomized clinical trials are either proposed or under way in North America and Europe to evaluate the precise role of carotid endarterectomy in the prevention of strokes. The basis for the current questioning of carotid endarterectomy and the rationale for these trials are addressed in this review.
自20世纪50年代以来，颈动脉内膜切除术已被广泛认可为一种重要的预防中风的手段，尽管在有症状或无症状患者的随机对照临床试验中缺乏其疗效的确切证据。虽然无症状性颈动脉疾病的手术治疗一直存在争议，但现在有症状患者接受颈动脉内膜切除术的适应症和益处也受到了质疑，尽管现有证据表明，由专业人员实施该手术，可降低轻度颈动脉区域缺血事件和严重同侧颈动脉疾病患者后续中风的发生率。（发病率和死亡率超过3%是不可接受的，因此该手术应由熟练掌握此技术的人员进行）。对于每一位患者，都必须做出决定，即潜在的中风风险降低是否超过了即刻的手术中风或死亡风险。北美和欧洲正在进行或提议开展一些大型、昂贵且重要的随机临床试验，以评估颈动脉内膜切除术在预防中风方面的确切作用。本综述阐述了目前对颈动脉内膜切除术提出质疑的依据以及这些试验的理论基础。
