Abbott Anne L
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
Neurology Private Practice, Knox Private Hospital, Wantirna, VIC, Australia.
Front Neurol. 2022 Jun 21;13:739999. doi: 10.3389/fneur.2022.739999. eCollection 2022.
Carotid stenosis is arterial disease narrowing of the origin of the internal carotid artery (main brain artery). Knowing how to best manage this is imperative because it is common in older people and an important cause of stroke. Inappropriately high expectations have grown regarding the value of carotid artery procedures, such as surgery (endarterectomy) and stenting, for lowering the stroke risk associated with carotid stenosis. Meanwhile, the improving and predominant value of medical intervention (lifestyle coaching and medication) continues to be underappreciated.
This article aims to be an objective presentation and discussion of the scientific literature critical for decision making when the primary goal is to optimize patient outcome. This compilation follows from many years of author scrutiny to separate fact from fiction. Common sense conclusions are drawn from factual statements backed by original citations. Detailed research methodology is given in cited papers. This article has been written in plain language given the importance of the general public understanding this topic. Issues covered include key terminology and the economic impact of carotid stenosis. There is a summary of the evidence-base regarding the efficacy and safety of procedural and medical (non-invasive) interventions for both asymptomatic and symptomatic patients. Conclusions are drawn with respect to current best management and research priorities. Several "furphies" (misconceptions) are exposed that are commonly used to make carotid stenting and endarterectomy outcomes appear similar. Ongoing randomized trials are mentioned and why they are unlikely to identify a routine practice indication for carotid artery procedures. There is a discussion of relevant worldwide guidelines regarding carotid artery procedures, including how they should be improved. There is an outline of systematic changes that are resulting in better application of the evidence-base.
The cornerstone of stroke prevention is medical intervention given it is non-invasive and protects against all arterial disease complications in all at risk. The "big" question is, does a carotid artery procedure add patient benefit in the modern era and, if so, for whom?
颈动脉狭窄是一种动脉疾病，即颈内动脉（主要脑动脉）起始处变窄。了解如何最佳地管理这一疾病至关重要，因为它在老年人中很常见，且是中风的重要病因。对于颈动脉手术（如内膜切除术）和支架置入术等颈动脉手术在降低与颈动脉狭窄相关的中风风险方面的价值，人们产生了过高的期望。与此同时，医疗干预（生活方式指导和药物治疗）不断提高的显著价值仍未得到充分重视。
本文旨在客观呈现和讨论对决策至关重要的科学文献，首要目标是优化患者预后。这一汇编源于作者多年的审视，以区分事实与虚构。从有原始引用支持的事实陈述中得出常识性结论。引用论文中给出了详细的研究方法。鉴于公众理解这一主题的重要性，本文采用通俗易懂的语言撰写。涵盖的问题包括关键术语以及颈动脉狭窄的经济影响。总结了关于无症状和有症状患者的手术及医疗（非侵入性）干预的疗效和安全性的证据基础。得出了关于当前最佳管理和研究重点的结论。揭示了一些常用于使颈动脉支架置入术和内膜切除术结果看起来相似的“误解”。提及了正在进行的随机试验以及它们为何不太可能确定颈动脉手术的常规应用指征。讨论了关于颈动脉手术的相关全球指南，包括应如何改进这些指南。概述了正在导致更好地应用证据基础的系统性变化。
鉴于医疗干预是非侵入性的且能预防所有有风险人群的所有动脉疾病并发症，因此它是预防中风的基石。“重大”问题是，在现代，颈动脉手术是否能给患者带来益处，如果能，对哪些人有益？
