de Donato Gianmarco, Setacci Francesco, Pasqui Edoardo, Benevento Domenico, Palasciano Giancarlo, Sterpetti Antonio, di Marzo Luca, Setacci Carlo
Department of Surgery, Unit of Vascular and Endovascular Surgery, University of Siena, Viale Bracci, 53100 Siena Siena, Italy.
Department of Vascular Surgery, Casa di Cura Giovanni XXIII, Monastier di Treviso, Italy.
Semin Vasc Surg. 2018 Mar;31(1):15-20. doi: 10.1053/j.semvascsurg.2018.02.001. Epub 2018 Feb 22.
Multicenter clinical trials level 1 evidence favors the application of carotid endarterectomy in symptomatic patients, especially the in the elderly cohort. Carotid artery stenting has been proposed as a possible early alternative in selected patients after onset of ipsilateral neurologic symptoms. It is well known that treatment of acute stroke is time-dependent in patients with acute ischemic stroke caused by high-grade stenosis of the internal carotid artery, but intensive medical treatment in conjunction with intervention to improve stroke severity and clinical outcomes has not been established. Two major clinical concerns exist: (1) the risk of hemorrhagic infarction after cerebral revascularization in the acute stage and (2) application of carotid stenting in the acute embolic stage, which may be associated with continued embolic risk after carotid artery stenting compared to carotid endarterectomy, which removes the symptomatic plaque. This review summarizes the indications and results of early carotid artery stenting after onset of neurologic symptoms, considering the new carotid stents and cerebral protection systems available for clinical use and enhanced stenting techniques.
一级证据的多中心临床试验支持在有症状的患者中应用颈动脉内膜切除术，尤其是老年患者群体。对于同侧神经症状发作后的特定患者，颈动脉支架置入术已被提议作为一种可能的早期替代方法。众所周知，对于由颈内动脉高度狭窄引起的急性缺血性卒中患者，急性卒中的治疗具有时间依赖性，但强化药物治疗与改善卒中严重程度和临床结局的干预措施尚未确立。存在两个主要临床问题：（1）急性期脑血运重建后出血性梗死的风险；（2）在急性栓塞期应用颈动脉支架置入术，与颈动脉内膜切除术（可去除有症状斑块）相比，颈动脉支架置入术后可能存在持续的栓塞风险。本综述总结了神经症状发作后早期颈动脉支架置入术的适应证和结果，同时考虑了可用于临床的新型颈动脉支架和脑保护系统以及改进的支架置入技术。
