Department of Neurosurgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
Adv Tech Stand Neurosurg. 2022;44:187-207. doi: 10.1007/978-3-030-87649-4_10.
Stroke is the second leading cause of death worldwide. One of the main causes of stroke is carotid artery stenosis. Stenosis with atherosclerosis in the carotid artery can cause stroke by hemodynamic ischemia or artery to artery embolism. A most common surgical intervention for carotid artery stenosis is carotid endarterectomy (CEA). Many studies on CEA have been reported and suggested medical indications. For symptomatic carotid stenosis, generally, CEA may be indicated for patients with more than 50% stenosis and is especially beneficial in men, patients aged 75 years or older, and patients who underwent surgery within 2 weeks of their last symptoms. For asymptomatic carotid stenosis, CEA may be indicated for those with more than 60% stenosis, though each guideline has different suggestions in detail. In order to evaluate the indication for CEA in each case, it is important to assess risks for CEA carefully including anatomical factors and comorbidities, and to elaborate each strategy for each operation based on preoperative imaging studies including carotid ultrasonography, magnetic resonance imaging and angiography. In surgery there are many tips on operative position, procedure, shunt usage and monitoring to perform a safe and smooth operation. Now that carotid artery stenting has been rapidly developed, better understanding for CEA is required to treat carotid artery stenosis adequately. This chapter must be a good help to understand CEA well.
中风是全球范围内的第二大致死原因。中风的主要原因之一是颈动脉狭窄。颈动脉粥样硬化引起的狭窄可通过血液动力学缺血或动脉至动脉栓塞导致中风。颈动脉狭窄的一种最常见的手术干预方法是颈动脉内膜切除术(CEA)。已经有许多关于 CEA 的研究报告并提出了医学适应证。对于有症状的颈动脉狭窄,一般来说,狭窄超过 50%的患者可能需要 CEA,尤其是男性、75 岁或以上的患者以及在最后一次症状发作后 2 周内接受手术的患者受益更大。对于无症状颈动脉狭窄,狭窄超过 60%的患者可能需要 CEA,但每个指南在细节上都有不同的建议。为了评估每个病例 CEA 的适应证,仔细评估 CEA 的风险非常重要,包括解剖因素和合并症,并根据术前影像学研究(包括颈动脉超声、磁共振成像和血管造影)为每个手术制定详细的策略。在手术中,有许多关于手术体位、手术过程、分流器使用和监测的技巧,可以安全顺利地进行手术。现在颈动脉支架置入术已经迅速发展,需要更好地了解 CEA,以充分治疗颈动脉狭窄。本章对于理解 CEA 非常有帮助。