Montorsi Piero, Galli Stefano, Ravagnani Paolo M, Roffi Marco
Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Division of Cardiology, University Hospital, Geneva, Switzerland.
Prog Cardiovasc Dis. 2017 May-Jun;59(6):601-611. doi: 10.1016/j.pcad.2017.04.002. Epub 2017 Apr 22.
Patients with symptomatic carotid artery disease should be managed by a multidisciplinary team including neurologists, vascular surgeons and interventionalists. Duplex ultrasound is the most widely used diagnostic modality to assess carotid disease, followed by additional imaging tests (CT- or MR-angiography) to confirm the severity of the stenosis, detect brain lesions, and assess intracranial circulation as well as the supra-aortic anatomy. Although overall randomized trial results favored (CEA) over carotid artery stenting (CAS) in symptomatic patients, this was likely related to the insufficient expertise of the endovascular specialists in several of the trials. CAS should be considered as a valid alternative to CEA in patients with favorable anatomy and in those at high-surgical risk, provided it is performed by experienced operators in high volume centers. Under those circumstances, it is reasonable to offer the patients the two options (CEA or CAS) after description of pros and cons of each therapy. CAS results may be further improved by better patient selection, new techniques, and technology advancements.
有症状的颈动脉疾病患者应由包括神经科医生、血管外科医生和介入专家在内的多学科团队进行管理。双功超声是评估颈动脉疾病最广泛使用的诊断方法，其次是额外的影像学检查（CT血管造影或MR血管造影），以确认狭窄的严重程度、检测脑部病变、评估颅内循环以及主动脉弓上的解剖结构。尽管总体随机试验结果显示，在有症状的患者中，颈动脉内膜切除术（CEA）优于颈动脉支架置入术（CAS），但这可能与一些试验中血管内专家的专业知识不足有关。在解剖结构合适且手术风险高的患者中，只要由经验丰富的操作人员在高容量中心进行，CAS应被视为CEA的有效替代方案。在这种情况下，在向患者描述每种治疗方法的利弊后，为患者提供两种选择（CEA或CAS）是合理的。通过更好的患者选择、新技术和技术进步，CAS的结果可能会进一步改善。
