Trobe J D
Ophthalmology. 1987 Jun;94(6):725-30. doi: 10.1016/s0161-6420(87)33388-3.
Although carotid endarterectomy is one of the most frequently performed operations in this country, recent evidence casts doubt on its advisability, particularly for patients with ocular manifestations of cerebral ischemia. The following evidence is that: the risk of future stroke in untreated patients with amaurosis fugax, retinal plaques, and infarcts is less than 3% per year, far lower than that expected for cerebral (hemispheric) transient ischemic attacks (TIAs); the perioperative risk of stroke and death after endarterectomy may be much higher than previously suspected; and aspirin is a comparatively risk-free and moderately effective alternative to endarterectomy. Because of the questions raised about the risk-to-benefit ratio of endarterectomy, patients with ocular manifestations of cerebral ischemia should be considered for this operation only as part of a proposed randomized collaborative study.
尽管颈动脉内膜切除术是该国最常开展的手术之一，但最近的证据对其适用性提出了质疑，尤其是对有脑缺血眼部表现的患者。以下是相关证据：患有一过性黑矇、视网膜斑块和梗死的未经治疗患者未来发生中风的风险每年低于3%，远低于脑（半球）短暂性脑缺血发作（TIA）的预期风险；内膜切除术后中风和死亡的围手术期风险可能比之前怀疑的要高得多；阿司匹林是一种相对无风险且效果中等的内膜切除术替代方案。由于对内膜切除术风险效益比提出了疑问，有脑缺血眼部表现的患者应仅作为拟议的随机协作研究的一部分来考虑进行该手术。
