Moore W S
Section of Vascular Surgery, University of California, Los Angeles, School of Medicine.
West J Med. 1993 Jul;159(1):37-43.
Carotid endarterectomy, a frequently performed operation, has been used as a strategy for preventing stroke in patients with carotid bifurcation disease. The safety and efficacy of the operation were recently challenged by a number of sources. Three major responses to this challenge were to retrospectively review the natural history of carotid bifurcation disease compared with the immediate and long-term results of carotid endarterectomy, to initiate 6 prospective randomized trials to determine the efficacy of carotid endarterectomy for a variety of indications, and to develop appropriateness initiatives and guidelines for using this surgical procedure by organizations concerned with health care policy. I review the current status of these 3 areas of endeavor. In those areas where studies are complete, carotid endarterectomy has been shown to be highly effective in reducing stroke risk. Risk reduction has ranged from 66% to 80% compared with medical management. Based on these sources and findings, I present a list of indications for the operation for surgeons who are able to do the operation safely and within the guidelines established by the Stroke Council of the American Heart Association.
颈动脉内膜切除术是一种常施行的手术，已被用作预防颈动脉分叉疾病患者中风的一种策略。该手术的安全性和有效性最近受到了一些质疑。针对这一质疑的三种主要应对措施是：回顾性地比较颈动脉分叉疾病的自然病程与颈动脉内膜切除术的近期和长期结果；开展6项前瞻性随机试验，以确定颈动脉内膜切除术对各种适应症的疗效；以及由关注医疗保健政策的组织制定使用该手术程序的适宜性倡议和指南。我将审视这三个努力领域的现状。在那些研究已经完成的领域，颈动脉内膜切除术已被证明在降低中风风险方面非常有效。与药物治疗相比，风险降低幅度在66%至80%之间。基于这些资料和研究结果，我为那些能够安全地按照美国心脏协会中风委员会制定的指南进行手术的外科医生列出了该手术的适应症清单。
