MBBS, GDipSurgAnat, Principal House Officer, Department of Vascular Surgery, Princess Alexandra Hospital, Woolloongabba, Qld.
MBBS (Hons), BMedSc (Hons), Medical Intern, Monash Health, Melbourne, Vic.
Aust J Gen Pract. 2021 Nov;50(11):821-825. doi: 10.31128/AJGP-10-20-5664.
Carotid artery stenosis (CAS) is one of the major causes of acute ischaemic stroke, accounting for approximately 20% of cases. It is not always symptomatic; however, when it is, the neurological vascular territory it commonly affects is the anterior circulation of the brain, causing symptoms such as hemiplegia, dysphasia or vision loss.
The aim of this article is to review the current literature on CAS, summarise the main updates and evidence base for surgical management, and discuss when vascular surgical input may be beneficial.
CAS can be classified as symptomatic or asymptomatic disease. Carotid endarterectomy remains important in the treatment of symptomatic disease because of a strong evidence base for its benefit in the overall reduction of recurrent stroke risk. The benefit of surgery is less clear for asymptomatic disease. Commencement of best medical therapy as well as cardiovascular risk factor modification is a mainstay of treatment for both groups of patients.
颈动脉狭窄（CAS）是急性缺血性脑卒中的主要原因之一，约占病例的 20%。它并不总是有症状的；然而，当它有症状时，它通常影响的是大脑的前循环，导致偏瘫、失语或视力丧失等症状。
本文旨在回顾目前关于 CAS 的文献，总结手术治疗的主要更新和循证依据，并讨论何时血管外科干预可能有益。
CAS 可分为有症状或无症状疾病。颈动脉内膜切除术在治疗有症状疾病方面仍然很重要，因为其在总体降低复发性中风风险方面有强有力的证据支持。手术治疗对无症状疾病的益处则不太明确。对于这两组患者，开始最佳药物治疗以及心血管危险因素的修正都是治疗的主要方法。
