Vascular Neurology Division, Department of Neurology, Mayo Clinic, Jacksonville, FL.
Stroke. 2022 Apr;53(4):e145-e149. doi: 10.1161/STROKEAHA.121.037269. Epub 2022 Mar 1.
The recent 130-center, international, second ACST trial (Asymptomatic Carotid Surgery Trial) involving 3625 patients found that regardless of whether a patient underwent stenting or endarterectomy, the periprocedural risk of disabling or fatal stroke was about 1% and the 5-year estimated risk of nonprocedural disabling or fatal stroke was 2.5%. With advances in technique, technology, and patient selection, stenting done by appropriately trained and experienced operators can achieve safety and efficacy comparable to endarterectomy for asymptomatic patients. The ongoing CREST-2 trial (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) will clarify whether revascularization, by either stenting or endarterectomy, remains an important therapeutic goal in the setting of modern intensive medical therapy.
最近一项涉及 3625 名患者的 130 个中心、国际性的第二代 ACST 试验（无症状颈动脉手术试验）发现，无论患者接受支架置入术还是内膜切除术，围手术期致残性或致死性卒中风险约为 1%，5 年非手术致残性或致死性卒中风险估计为 2.5%。随着技术、技术和患者选择的进步，由经过适当培训和经验丰富的操作者进行的支架置入术可以实现与无症状患者的内膜切除术相当的安全性和疗效。正在进行的 CREST-2 试验（无症状颈动脉狭窄的颈动脉血运重建和药物治疗试验）将阐明，在现代强化药物治疗的背景下，通过支架置入术或内膜切除术进行血运重建是否仍然是一个重要的治疗目标。
