Bounajem Michael T, Grandhi Ramesh, Kilburg Craig J, Taussky Philipp
Clinical Neurosciences Center, Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA.
J Pers Med. 2022 May 27;12(6):882. doi: 10.3390/jpm12060882.
Carotid artery stenosis is a major cause of acute ischemic strokes in adults. Given the consequences and sequelae of an acute ischemic stroke, intervention while patients are still asymptomatic is a key opportunity for stroke prevention. Although carotid endarterectomy has been the gold standard of treatment for carotid stenosis for many years, recent advances in carotid stenting technology, practitioner experience, and dual antiplatelet therapy have expanded the use for treatments other than endarterectomy. Review of the current literature has demonstrated that endarterectomy and carotid artery stenting produce overall similar results for the treatment of asymptomatic carotid stenosis, but certain factors may help guide physicians and patients in choosing one treatment over the other. Age 70 years and older, renal disease, poor medication compliance, and unstable plaque features all portend better outcomes from endarterectomy, whereas age under 70 years, high cervical location of disease, cardiac disease, and reliable medication compliance favor stenting. The decision to pursue endarterectomy versus stenting is therefore complex, and although large studies have demonstrated similar outcomes, the approach to treatment of asymptomatic carotid stenosis must be optimized for each individual patient to achieve the best possible outcome.
颈动脉狭窄是成人急性缺血性卒中的主要病因。鉴于急性缺血性卒中的后果和后遗症，在患者仍无症状时进行干预是预防卒中的关键时机。尽管多年来颈动脉内膜切除术一直是治疗颈动脉狭窄的金标准，但近年来颈动脉支架置入技术、术者经验以及双联抗血小板治疗的进展扩大了内膜切除术以外其他治疗方法的应用。对当前文献的综述表明，内膜切除术和颈动脉支架置入术在治疗无症状性颈动脉狭窄方面总体结果相似，但某些因素可能有助于指导医生和患者选择一种治疗方法而非另一种。70岁及以上、肾病、药物依从性差和斑块特征不稳定均预示着内膜切除术的预后更好，而70岁以下、病变位于高位颈椎、心脏病和可靠的药物依从性则有利于支架置入术。因此，选择内膜切除术还是支架置入术的决定很复杂，尽管大型研究表明结果相似，但无症状性颈动脉狭窄的治疗方法必须针对每个患者进行优化，以实现最佳预后。
