Wabnitz Ashley M, Turan Tanya N
Division of Neurology, Medical University of South Carolina, 19 Hagood Ave, Harborview Office Tower Suite 501, Charleston, SC, 29425-8050, USA.
Curr Treat Options Cardiovasc Med. 2017 Aug;19(8):62. doi: 10.1007/s11936-017-0564-0.
Symptomatic carotid artery disease is a significant cause of ischemic stroke, and these patients are at high risk for recurrent vascular events. Patients with symptoms of stroke or transient ischemic attack attributable to a significantly stenotic vessel (70-99% luminal narrowing) should be treated with intensive medical therapy. Intensive medical therapy is a combination of pharmacologic and lifestyle interventions consistent with best-known practices as follows: initiation of antiplatelet agent or anticoagulation if medically indicated, high potency statin medication, blood pressure control with goal blood pressure of greater than 140/90, Mediterranean-style diet, exercise, and smoking cessation. Further, patients who have extracranial culprit lesions should be considered for revascularization with either carotid endarterectomy or carotid angioplasty and stenting depending on several factors including the patient's anatomy, age, gender, and procedural risk. Based on current evidence, patients with symptomatic intracranial stenosis should be managed with intensive medical therapy, including the use of dual antiplatelet therapy with aspirin and clopidogrel for the first 90 days following the ischemic event. While the literature has shown a stronger benefit of revascularization of extracranial symptomatic disease among certain subgroups of patients with greater than 70% stenosis, there is less benefit from revascularization with endarterectomy in patients with moderate stenosis of 50-69% if the surgeon's risk of perioperative stroke or death rate is greater than 6%.
有症状的颈动脉疾病是缺血性中风的重要原因，这些患者发生复发性血管事件的风险很高。有因严重狭窄血管（管腔狭窄70 - 99%）导致的中风或短暂性脑缺血发作症状的患者，应接受强化药物治疗。强化药物治疗是药物和生活方式干预的组合，符合以下最知名的做法：根据医学指征启动抗血小板药物或抗凝治疗、使用高效他汀类药物、将血压控制在目标血压大于140/90、采用地中海式饮食、进行运动以及戒烟。此外，对于有颅外责任病变的患者，应根据包括患者解剖结构、年龄、性别和手术风险等多种因素，考虑采用颈动脉内膜切除术或颈动脉血管成形术及支架置入术进行血运重建。根据目前的证据，有症状的颅内狭窄患者应采用强化药物治疗，包括在缺血事件后的前90天使用阿司匹林和氯吡格雷进行双重抗血小板治疗。虽然文献表明，在某些管腔狭窄大于70%的亚组患者中，颅外有症状疾病的血运重建有更强的益处，但如果外科医生围手术期中风或死亡率大于6%，对于管腔中度狭窄50 - 69%的患者，内膜切除术血运重建的益处较小。
