Diener H C, Delcker A
Klinik und Poliklinik für Neurologie, Universität Essen.
Z Kardiol. 1993;82 Suppl 5:105-9.
Carotid endarterectomy until recently was performed to prevent the progression of a stenosis to an occlusion and hemodynamically induced strokes in patients with tight stenosis. Operation of ulcerated plaques or stenosis was supposed to prevent embolic stroke. The operation has no indication for a stenosis of the internal carotid artery (ICA) > 50% and < 90% in asymptomatic persons. Whether persons with an asymptomatic stenosis > 90% show a preventive effect of the operation is not known at this time. According to the Mayo-Clinic study, persons with asymptomatic ICA stenosis should be treated with aspirin to prevent myocardial infarction. Two large controlled trials have shown that endarterectomy can prevent stroke in patients with transient ischemic attacks (TIA) or minor stroke and an ICA-stenosis > 70%. This preventive effect is lost when the complication rate of the procedure is higher than 5% (mortality and morbidity). In patients with stenosis < 30% the operation has no preventive effect. Both studies continue to recruit patients with symptomatic stenoses between 30 and 70%. Patients with severe neurological deficits or a large lesion in CT should not be operated as would be patients with an acute stroke. The extra-intracranial bypass operation did not prevent stroke in patients with an occlusion of the ICA or severe stenosis or occlusion of the middle cerebral artery. Angioplasty has been applied to dilate stenoses of the subclavian artery in patients with subclavian-steal syndrome and disabling vertebro-basilar TIA. Angioplasty in the carotid artery is still an experimental procedure, which should only be applied in controlled trials.
直到最近，颈动脉内膜切除术仍用于预防狭窄进展为闭塞以及预防严重狭窄患者因血流动力学因素导致的中风。切除溃疡性斑块或狭窄病变被认为可以预防栓塞性中风。对于无症状者，颈内动脉（ICA）狭窄>50%且<90%时，该手术并无指征。目前尚不清楚无症状狭窄>90%的患者是否能从该手术中获得预防效果。根据梅奥诊所的研究，无症状ICA狭窄患者应使用阿司匹林进行治疗以预防心肌梗死。两项大型对照试验表明，对于短暂性脑缺血发作（TIA）或轻度中风且ICA狭窄>70%的患者，内膜切除术可预防中风。当手术并发症发生率高于5%（死亡率和发病率）时，这种预防效果就会丧失。对于狭窄<30%的患者，该手术没有预防作用。两项研究仍在招募症状性狭窄在30%至70%之间的患者。有严重神经功能缺损或CT显示有大面积病变的患者，以及急性中风患者均不应进行手术。颅外-颅内搭桥手术并不能预防ICA闭塞或大脑中动脉严重狭窄或闭塞患者的中风。血管成形术已被用于扩张锁骨下动脉窃血综合征和致残性椎基底动脉TIA患者的锁骨下动脉狭窄。颈动脉血管成形术仍是一种试验性手术，仅应在对照试验中应用。
