Pini Rodolfo, Vacirca Andrea, Palermo Sergio, Gallitto Enrico, Mascoli Chiara, Gargiulo Mauro, Faggioli Gianluca
Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy.
Ann Transl Med. 2020 Oct;8(19):1264. doi: 10.21037/atm-20-1098.
Patients with carotid artery stenosis (CAS) are commonly defined as asymptomatic or symptomatic according with their neurological conditions, however, emerging evidences suggest stratifying patients according also with the presence of cerebral ischemic lesions (CIL). In asymptomatic patients, the presence of CIL increases the risk of future neurologic event from 1% to 4% per year, leading to a stronger indication to carotid revascularization. In symptomatic patients, the presence of CIL does not seem to influence the outcome of the carotid revascularization if the volume of the lesion is small (<4,000 mm); the benefit of the revascularization is also more significant if performed within 2 weeks from the index event. However, high volume (>4,000 mm) CIL are associated in some experiences with a higher risk of carotid revascularization suggesting to delay the carotid revascularization for at least 4 weeks. As a matter of fact, the evaluation of CIL dimensions and characteristics in patients with CAS gives to the physician involved in the treatment a valuable adjunctive tool in the choice of the ideal treatment.
根据神经学状况，颈动脉狭窄（CAS）患者通常被定义为无症状或有症状的，然而，新出现的证据表明，也应根据脑缺血性病变（CIL）的存在对患者进行分层。在无症状患者中，CIL的存在使未来神经事件的风险每年从1%增加到4%，从而使颈动脉血运重建的指征更强。在有症状的患者中，如果病变体积较小（<4000立方毫米），CIL的存在似乎不会影响颈动脉血运重建的结果；如果在索引事件发生后2周内进行血运重建，其益处也更显著。然而，在一些经验中，大量（>4000立方毫米）的CIL与颈动脉血运重建的较高风险相关，这表明应将颈动脉血运重建至少推迟4周。事实上，对CAS患者CIL尺寸和特征的评估为参与治疗的医生在选择理想治疗方法时提供了一个有价值的辅助工具。
