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Endarterectomy versus stenting for stroke prevention

Stroke & Vascular Neurology 2018年第2期3卷 101-106页

作者： a ross naylor The Leicester Vascular Institute Glenfield HospitalLeicesterUK

The European Society for Vascular Surgery(ESVS)has recently prepared updated guidelines for the management of patients with symptomatic and asymptomatic atherosclerotic carotid artery disease,with specific reference to the roles of best medical therapy,carotid endarterectomy(CEA)and carotid artery stenting(CAS).In symptomatic patients,there is a drive towards performing carotid interventions as soon as possible after onset of *** is because it is now recognised that the highest risk period for recurrent stroke is the first 7-14 days after onset of *** guidelines advise that there is a role for both CEA and CAS,but the levels of evidence are slightly lower for CAS than for *** is because 30-day risks of death/stroke in the randomised controlled trials(RCTs)were significantly higher than after CEA(especially in the first 7-14 days after onset of symptoms)and there are concerns that the results obtained in the RCTs may not be generalisable into routine clinical *** asymptomatic patients,the 2018 ESVS guidelines were the first to recommend that CEA/CAS should be targeted into a smaller cohort of patients who may be‘higher risk for stroke’on medical *** with symptomatic patients,the ESVS guidelines advise that there is a potential role for both CEA and CAS,but the levels of evidence are again slightly lower for CAS than for *** is because 30-day risks of death/stroke in the two largest RCTs,which used credentialed(experienced CAS practitioners),were only just within the accepted 3%risk threshold and there remain concerns that the results obtained in RCTs may not be generalisable into routine clinical practice.

关键词： routine prevention Surgery

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