Kaufman H H, Voelker J L
Department of Neurosurgery, West Virginia University School of Medicine, Morgantown.
W V Med J. 1993 Mar;89(3):106-8.
Stroke is a major health problem in the United States. Carotid endarterectomy has been performed to prevent stroke in symptomatic and asymptomatic patients with carotid atherosclerosis. The rationale for this approach has been questioned recently and several studies were begun to determine the proper role of surgery. The initial results from studies of symptomatic patients demonstrate that surgery is urgently indicated if stenosis is at least 70%, but not if it is less than 30%. Patients with intermediate amounts of stenosis are still being evaluated. Early evidence suggests that surgery is not indicated for asymptomatic patients, but two major trials are still in progress. Surgeons performing this procedure must demonstrate low perioperative morbidity and mortality. In addition, the use of ultrasound as a screening procedure is being re-evaluated. We suggest rapid referral and evaluation of symptomatic patients with angiography, and treatment of asymptomatic patients with aspirin.
中风是美国的一个主要健康问题。对于有症状和无症状的颈动脉粥样硬化患者，已开展颈动脉内膜切除术以预防中风。最近，这种治疗方法的基本原理受到了质疑，并且已经启动了多项研究以确定手术的恰当作用。针对有症状患者的研究初步结果表明，如果狭窄程度至少达到70%，则急需进行手术，但如果狭窄程度小于30%，则无需手术。狭窄程度处于中间范围的患者仍在接受评估。早期证据表明，无症状患者无需进行手术，但两项大型试验仍在进行中。实施该手术的外科医生必须证明围手术期发病率和死亡率较低。此外，超声作为一种筛查手段的应用正在重新评估。我们建议对有症状的患者通过血管造影进行快速转诊和评估，对无症状患者采用阿司匹林进行治疗。
