Paraskevas Kosmas I, Mikhailidis Dimitri P, Baradaran Hediyeh, Davies Alun H, Eckstein Hans-Henning, Faggioli Gianluca, Fernandes Jose Fernandes E, Gupta Ajay, Jezovnik Mateja K, Kakkos Stavros K, Katsiki Niki, Kooi M Eline, Lanza Gaetano, Liapis Christos D, Loftus Ian M, Millon Antoine, Nicolaides Andrew N, Poredos Pavel, Pini Rodolfo, Ricco Jean-Baptiste, Rundek Tatjana, Saba Luca, Spinelli Francesco, Stilo Francesco, Sultan Sherif, Zeebregts Clark J, Chaturvedi Seemant
Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.
Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
J Stroke. 2021 May;23(2):202-212. doi: 10.5853/jos.2020.04273. Epub 2021 May 31.
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
无症状性颈动脉狭窄（ACS）患者的最佳管理是一个广泛讨论的话题。根据2017年欧洲血管外科学会指南，在存在一个或多个可能与同侧晚期卒中风险增加相关的临床/影像学特征（例如，脑部计算机断层扫描/磁共振成像上的无症状性栓塞性梗死、ACS严重程度进展、对侧短暂性脑缺血发作/卒中病史、经颅多普勒检测到微栓子等）的情况下，应进行颈动脉内膜切除术（IIa类；证据级别：B）或可考虑颈动脉支架置入术（IIb类；证据级别：B），前提是记录的围手术期卒中/死亡率<3%且患者预期寿命>5年。除了这些临床/影像学特征外，在决定这些患者的最佳管理方案时，可能还应评估其他个体、种族/民族或社会因素，如个体患者需求/患者选择、患者对最佳药物治疗的依从性、患者性别、文化、种族/民族、年龄和合并症，以及成像/手术技术/结果的改善。本多专业立场文件将阐述为何ACS患者的管理可能需要个体化的理由。
