Management of Patients with an Asymptomatic Carotid Stenosis—Medical Management, Endovascular Treatment, or Carotid Endarterectomy?
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  • 作者：J. David Spence
  • 关键词：Carotid stenosis ; Asymptomatic ; Management ; Intensive medical therapy ; Endarterectomy ; Stenting
  • 刊名：Current Neurology and Neuroscience Reports
  • 出版年：2016
  • 出版时间：January 2016
  • 年：2016
  • 卷：16
  • 期：1
  • 全文大小：3,341 KB
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  • 作者单位：J. David Spence (1)

    1. Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, ON, Canada, N6G 2V4
  • 刊物主题：Neurology; Neurosciences;
  • 出版者：Springer US
  • ISSN：1534-6293
    • 文摘
    Patients with asymptomatic carotid stenosis all warrant intensive medical therapy; they are at a higher risk of myocardial infarction than of stroke. With modern intensive medical therapy, the annual risk of ipsilateral is now ∼0.5 %. Justifying carotid intervention on the basis of the results of historic trials with a medical arm, extrapolated to modern trials with lower interventional risks but no medical arm is not legitimate. Most patients (∼90 %) with asymptomatic carotid stenosis would be better served by intensive medical therapy than by either stenting or endarterectomy. The few (∼10 %) who could benefit from intervention can be identified by microemboli on transcranial Doppler and other methods in development. Routine stenting of asymptomatic carotid stenosis, because it is more likely to harm than help the patient, may be considered unethical.

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