Lagneau P
Service de Chirurgie vasculaire, Hôpital Saint-Michel, Paris.
J Mal Vasc. 1993;18(3):209-12.
Results of recent randomized clinical trials in patients with asymptomatic carotid artery stenosis have progressively tended towards a more surgical than medical attitude to treatment. Interim results of the Veterans Administration study of 444 patients randomly allocated to receive either aspirin (233 cases) or surgery (211 cases) showed the percentage of vascular accidents and postoperative mortality to be 2.4% and 1.9% respectively in the surgical group, a marked reduction when compared with the 5% neurologic events reported in the medical group. In contrast, results of the Casanova Study, an equally randomized trial of 410 patients, 344 of whom underwent carotid endarterectomy, failed to demonstrate a significant difference in neurologic events or mortality between the two groups, although these were not homogeneous. Finally, the randomized French study (AURC) in 230 patients (135 operated upon and 109 treated medically with aspirin) showed a reduction in neurologic accidents in the surgical group, significant after a follow up of about 45 months. This tendency towards a surgical approach implies a low surgical morbidity/mortality, now possible due to local and regional plexus anesthesia monitoring, which carries a morbidity of less than 2% and a practically inexistent mortality.
近期针对无症状性颈动脉狭窄患者的随机临床试验结果越来越倾向于采取手术治疗而非药物治疗。退伍军人管理局对444例患者进行的研究，将其随机分为两组，分别接受阿司匹林治疗（233例）或手术治疗（211例），中期结果显示手术组血管意外发生率和术后死亡率分别为2.4%和1.9%，与药物组报告的5%的神经事件相比有显著降低。相比之下，卡萨诺瓦研究对410例患者进行了同样的随机试验，其中344例接受了颈动脉内膜切除术，尽管两组并非同质，但该研究未能证明两组在神经事件或死亡率方面存在显著差异。最后，法国对230例患者进行的随机研究（AURC）（135例接受手术，109例接受阿司匹林药物治疗）显示，手术组的神经意外有所减少，在约45个月的随访后具有统计学意义。这种倾向于手术治疗的趋势意味着手术的发病率/死亡率较低，由于局部和区域神经丛麻醉监测，现在这是可能的，其发病率低于2%，死亡率几乎不存在。
