Carreira Mariana, Duarte-Gamas Luís, Rocha-Neves João, Andrade José Paulo, Fernando-Teixeira José
Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal.
Rev Port Cir Cardiotorac Vasc. 2020 Jul-Sep;27(3):159-166.
An asymptomatic carotid stenosis (CS) is defined as a stable atherosclerotic luminal narrowing in patients with no history of ipsilateral cerebral or ocular ischemic events in the past six months. The bifurcation of the common carotid artery makes this area vulnerable to atherosclerosis due to the features of haemodynamic flow. The exact prevalence of asymptomatic patients with CS remains unknown and opinions on the treatment of these patients are controversial.
The authors aimed to review the evidence on the management of the asymptomatic CS and describe its clinical characteristics, diagnosis and treatment management.
A comprehensive review of the literature was carried out to collate data from relevant studies concerning patients with extracranial moderate to severe asymptomatic carotid stenosis. The data used was identified by a search using PubMed and Google Scholar with the keywords / MESH terms "carotid stenosis", in combination with the term "asymptomatic". For this study, the authors focused on publications in the past two decades, using English publications.
A few studies have addressed the prevalence, natural course and/or prognostic impact of asymptomatic CS in patients under medical treatment or undergoing vascular surgery procedures. The prevalence of asymptomatic CS ranged from 0.3% to 4.5% in women and 0.5% to 5.7% in men - The risk of stroke/TIA in these patients was reported between 2% to 5% annually with a downward trend across time to 0.5% with current best medical therapy.
A great proportion of patients with asymptomatic CS should be submitted to conservative management with best medical therapy. However, selective surgical management should be considered if high risk features are present.
无症状性颈动脉狭窄（CS）定义为在过去六个月内无同侧脑或眼部缺血事件病史的患者中出现的稳定的动脉粥样硬化管腔狭窄。由于血流动力学特点，颈总动脉分叉处易发生动脉粥样硬化。无症状性CS患者的确切患病率尚不清楚，对于这些患者的治疗意见也存在争议。
作者旨在综述无症状性CS管理的证据，并描述其临床特征、诊断和治疗管理。
对文献进行全面综述，以整理来自有关颅外中度至重度无症状性颈动脉狭窄患者的相关研究的数据。所使用的数据通过在PubMed和谷歌学术上使用关键词/MESH术语“颈动脉狭窄”并结合术语“无症状”进行搜索来确定。对于本研究，作者重点关注过去二十年的英文出版物。
一些研究探讨了无症状性CS在接受药物治疗或血管外科手术患者中的患病率、自然病程和/或预后影响。无症状性CS的患病率在女性中为0.3%至4.5%之间，在男性中为0.5%至5.7%之间。据报道，这些患者每年发生中风/TIA的风险在2%至5%之间，随着时间推移呈下降趋势，采用目前最佳药物治疗时降至0.5%。
很大一部分无症状性CS患者应采用最佳药物治疗进行保守管理。然而，如果存在高风险特征，则应考虑选择性手术管理。
