Dossabhoy Shernaz, Arya Shipra
Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway M121-P, MC 5639, Stanford, CA 94305.
Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway M121-P, MC 5639, Stanford, CA 94305.
Semin Vasc Surg. 2021 Mar;34(1):3-9. doi: 10.1053/j.semvascsurg.2021.02.013. Epub 2021 Feb 12.
Atherosclerotic carotid artery disease is a significant cause of stroke in the United States and globally. Its prevalence increases with age and it is more prevalent in men and White and Native-American populations. However, the outcomes related to carotid disease are worse in women and Black patients. Research suggests the disparities exist due to a multitude of factors, including disease pathophysiology, access to care, provider bias, and socioeconomic status. The prevalence of carotid stenosis in the general population is low (3%), and routine screening for carotid stenosis is not recommended in adults. Randomized clinical trials have shown benefits of stroke risk reduction with surgery (carotid endarterectomy or stenting) for symptomatic patients. Management is controversial in asymptomatic patients, as modern medical management has results equivalent to those of surgery and ongoing randomized clinical trials will address this important question. Carotid surgery is not appropriate in asymptomatic patients with limited life expectancy. Future work should explore comprehensive care models for care of patients with carotid disease and assessment of patient-reported outcomes to measure quality of care.
在美国和全球范围内，动脉粥样硬化性颈动脉疾病是中风的一个重要原因。其患病率随年龄增长而增加，在男性以及白人和美国原住民人群中更为普遍。然而，颈动脉疾病在女性和黑人患者中的预后更差。研究表明，这些差异的存在是由于多种因素造成的，包括疾病病理生理学、医疗服务可及性、医疗提供者的偏见以及社会经济地位。一般人群中颈动脉狭窄的患病率较低（3%），不建议对成年人进行常规的颈动脉狭窄筛查。随机临床试验表明，对于有症状的患者，手术（颈动脉内膜切除术或支架置入术）可降低中风风险。对于无症状患者，治疗存在争议，因为现代药物治疗的效果与手术相当，正在进行的随机临床试验将解决这个重要问题。对于预期寿命有限的无症状患者，颈动脉手术并不合适。未来的工作应探索针对颈动脉疾病患者的综合护理模式，并评估患者报告的结果以衡量护理质量。
