颈动脉内膜剥脱术治疗症状性颈动脉狭窄的几个重要问题

外科研究与新技术 ›› 2012, Vol. 1 ›› Issue (1): 23-26.

颈动脉内膜剥脱术治疗症状性颈动脉狭窄的几个重要问题

王飞

同济大学附属同济医院神经外科,上海 200065

出版日期:2012-09-28 发布日期:2012-01-25
作者简介:王飞(1974-), 男, 副主任医师, 硕士研究生导师, 医学博士, 研究脑血管病的基础与临床. E-mail:wangf_sh@sina.com.cn

Some key points on treatment of symptomatic carotid artery stenosis by carotid endarterectomy

Wang Fei

Department of Neurosurgery, Tongji Hospital of Tongji University, Shanghai 200065, China

Online:2012-09-28 Published:2012-01-25

摘要/Abstract

摘要： 脑卒中是当今造成人类死亡的第三大原因, 颈动脉狭窄是导致缺血性卒中事件发生的最常见原因。颈动脉内膜剥脱术是通过外科方法将堵塞在颈动脉内的斑块取出, 使血流通过得以通畅, 从而预防中风。20世纪90年代已有多个随机对照试验证实颈动脉内膜剥脱术相比于内科药物治疗对于预防卒中具有明显优势。本文就颈动脉内膜剥脱术的几个重要问题进行阐述, 有利于临床医生更好地了解颈动脉内膜剥脱术与缺血性脑卒中治疗的关系, 以有利于在中国不断推广这项技术。

关键词: 颈动脉内膜剥脱术, 颈动脉狭窄

Abstract: Stroke is the third leading cause of death recently.Carotid artery stenosis is the leading cause of ischemic stroke events.The carotid endarterectomy(CEA)is a surgical method which removes the plaque in the carotid artery through surgical method,so that the blood flow can be restored and stroke prevented.In the 1990s,there were many randomized controlled trials that proved carotid endarterectomy,compared with medical therapy,had many advantages in the prevention of stroke.This article describes some advances in some key points on treatment of symptomatic carotid artery stenosis by CEA,which will help more clinicians to have a better understanding of the relationship between CEA and ischemic stroke,thus encouraging them to continue to popularize this technology in China.

Key words: Carotid endarterectomy, Carotid stenosis

中图分类号:

R653

王飞. 颈动脉内膜剥脱术治疗症状性颈动脉狭窄的几个重要问题[J]. 外科研究与新技术, 2012, 1(1): 23-26.

Wang Fei. Some key points on treatment of symptomatic carotid artery stenosis by carotid endarterectomy[J]. 外科研究与新技术, 2012, 1(1): 23-26.

参考文献

[1] Eastcott HH,Pickering GW,Rob CG.Reconstruction of internal carotid in patient with intermittent attacks of hemiplegia[J].Lancet,1954,2(6546):994-996.
[2] Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.Endarterectomy for asymptomatic carotid artery stenosis[J].JAMA,1995,273(18):1421-1428.
[3] Ballotta E,Da Giau G,Baracchini C,et al.Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke:A prospective randomized study[J].Surgery,2002,131(3):287-293.
[4] Doig D,Brown MM.Carotid stenting versus endarterectomy[J].Annu Rev Med,2012,63(6):259-276.
[5] Eckstein HH,Ringleb P,Dorfler A,et al.The carotid surgery for ischemic stroke trial:A prospective observation study on carotid endarterectomy in the early period after ischemic stroke[J].J Vasc Surg,2002,36(5):997-1004.
[6] Welsh S,Mead G,Chant H,et al.Early carotid surgery in acute stroke:A multicenter randomised pilot study[J].Cerebrovasc Dis,2004,18(3):200-205.
[7] Rothwell PM,Eliasziw M,Gutnikov SA,et al.For the carotid endarterectomy trialists collaboration:Effect of endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and to the timing of surgery[J].Lancet,2004,363(9413):915-925.
[8] Claudio B,Giorgio M,Enzo B.Early carotid endarterectomy in acute sroke[J].Cerebrovasc Dis,2005,19(6):417-418.
[9] Taussky P,Sangala JR,Meyer FB.Carotid endarterectomy and treatment options for carotid occlusive disease[J].World Neurosurg.2011,76(6 Suppl):S35-39.
[10] Ballotta E,Da Giau G.Selective shunting with eversion carotid endarterectomy[J].J Vasc Surg,2003,38(5):1045-1050.
[11] Belardi P,Lucertini G,Emirio D.Stump pressure and transcranial Doppler for predicting shunting in carotid endarterectomy[J].Eur J Vasc Surg,2003,25(2):164-167.
[12] Cazaban S,Maiza D,Coffin O,et al.Surgical treatment of recurrent carotid artery stenosis and carotid artery stenosis after neck irradiation:evaluation of operative risk[J].Ann Vasc Surg,2003,17(4):393-400.
[13] Abbas K,Vohra RS,Salhab M,et al.A strategy to meet the “two-week” target for carotid endarterectomy in symptomatic patients[J].Clin Med,2011,11(5):452-455.
[14] ODonnell TF,Rodriguez AA,Fortunate JE,et al.Management of recurrent carotid stenosis:should asymptomatic lesions be treated surgically?[J].J Vasc Surg,1996,24(2):207-212.
[15] Mehta M,Roddy MPH,Darling R,et al.Safety and efficacy of eversion carotid endarterectomy for the treatment of recurrent stenosis:20-year experience[J].Ann Vasc Surg,2005,19(4):492-498.
[16] Cosottini M,Michelassi MC,Bencivelli W,et al.In stent restenosis predictors after carotid artery stenting[J].Stroke Res Treat,2010,14(3):764-772.
[17] Stolker JM,Mahoney EM,Safley DM,et al.Health-related quality of life following carotid stenting versus endarterectomy:results from the SAPPHIRE (Stenting and angioplasty with protection in patients at high Risk for endarterectomy) trial[J].JACC Cardiovasc Interv,2010,3(5):515-523.
[18] SPACE Collaborative Group,Ringleb PA,Allenberg J,et al.30 day results from the SPACE trial of stent protected angioplasty versus carotid endarterectomy in symptomatic patients:a randomized non-inferiority tria[J]l.Lancet,2006,368 (9543):1239-1247.
[19] Mas Jean-Louis JL,Gilles Chatellier,Bernard Beyssen,et al.Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis[J].N Engl J Med,2006,355(16):1660-1671.
[20] Brott TG,Hobson RW,George Howard,et al.Stenting versus endarterectomy for treatment of carotid artery stenosis[J].N Engl J Med,2010,(363):11-23.
[21] Xiromeritis K,Dalainas I,Stamatakos M,et al.Acute carotid stent thrombosis after carotid artery stenting[J].Eur Rev Med Pharmacol Sci,2012,16(3):355-362.