Hackam Daniel G
Division of Clinical Pharmacology, Department of Medicine, Department of Clinical Neurological Sciences, and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Stroke. 2021 Jun;52(6):2191-2198. doi: 10.1161/STROKEAHA.120.033994. Epub 2021 May 5.
Asymptomatic carotid stenosis (ACS) due to atherosclerosis is a risk factor for ipsilateral ischemic cerebrovascular events and cognitive impairment. The prognosis of ACS has improved over the past 4 decades due largely to improvements in medical management. Most patients with ACS can be managed without revascularization, but some patients with vulnerable plaque should be considered for revascularization. Regardless of the decision to refer for revascularization, all patients with ACS should receive intensive medical management. This includes lifestyle modification (Mediterranean diet, exercise, and smoking cessation) and pharmacological therapy (antiplatelets, lipid-lowering agents, blood pressure reduction, and glycemic control). Patients with ACS often have atherosclerosis in other critical locations, and thus optimal medical therapy is likely to reduce events outside the carotid arteries. The nature of optimal medical therapy is described.
动脉粥样硬化所致无症状性颈动脉狭窄（ACS）是同侧缺血性脑血管事件和认知障碍的危险因素。在过去40年中，ACS的预后有了改善，这主要归功于医疗管理的进步。大多数ACS患者无需血管重建即可得到治疗，但一些有易损斑块的患者应考虑进行血管重建。无论是否决定进行血管重建，所有ACS患者都应接受强化医疗管理。这包括生活方式改变（地中海饮食、运动和戒烟）以及药物治疗（抗血小板药物、降脂药物、降压药物和血糖控制）。ACS患者在其他关键部位常存在动脉粥样硬化，因此最佳药物治疗可能会减少颈动脉以外部位的事件。文中描述了最佳药物治疗的性质。
