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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Carotid endarterectomy: a review.
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Carotid endarterectomy: a review.

机译：颈动脉内膜切除术：审查。

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BACKGROUND: Since the validation of carotid endarterectomy (CEA) as an effective means of stroke prevention, there has been renewed interest in its best indications and methods, as well as in how it compares to carotid angioplasty and stenting (CAS). This review examines these topics, as well as the investigation of carotid stenosis and the role of auditing and reporting CEA results. INVESTIGATION: Brain imaging with CT or MRI should be obtained in patients considered for CEA, in order to document infarction and rule out mass lesions. Carotid investigation begins with ultrasound and, if results agree with subsequent, good-quality MRA or CT angiography, treatment can be planned and catheter angiography avoided. An equally acceptable approach is to proceed directly from ultrasound to catheter angiography, which is still the gold-standard in carotid artery assessment. INDICATIONS: Appropriate patients for CEA are those symptomatic with transient ischemic attacks or nondisabling stroke due to 70-99% carotid stenosis; the maximum allowable stroke and death rate being 6%. Uncertain candidates for CEA are those with 50-69% symptomatic stenosis, and those with asymptomatic stenosis > or = 60% but, if selected carefully on the basis of additional risk factors (related to both the carotid plaque and certain patient characteristics), some will benefit from surgery. Asymptomatic patients will only benefit if surgery can be provided with exceptionally low major complication rates (3% or less). Inappropriate patients are those with less than 50% symptomatic or 60% asymptomatic stenosis, and those with unstable medical or neurological conditions. TECHNIQUES: Carotid endarterectomy can be performed with either regional or general anaesthesia and, for the latter, there are a number of monitoring techniques available to assess cerebral perfusion during carotid cross-clamping. While monitoring cannot be considered mandatory and no single monitoring technique has emerged as being clearly superior, EEG is most commonly used. "Eversion" endarterectomy is a variation in surgical technique, and there is some evidence that more widely practiced patch closure may reduce the acute risk of operative stroke and the longer-term risk of recurrent stenosis. CAROTID ANGIOPLASTY AND STENTING: Experience with this endovascular and less invasive procedure grows, and its technology continues to evolve. Some experienced therapists have reported excellent results in case series and a number of randomized trials are now underway comparing CAS to CEA. However, at this time it is premature to incorporate CAS into routine practice replacing CEA. AUDITING: It has been shown that auditing of CEA indications and results with regular feed-back to the operating surgeons can significantly improve the performance of this operation. Carotid endarterectomy auditing is recommended on both local and regional levels.
机译：背景：自从颈动脉内膜切除术（CEA）作为预防中风的有效方法得到验证以来，人们对其最佳适应症和方法以及与颈动脉血管成形术和支架置入术（CAS）的比较方式引起了新的兴趣。这项审查审查这些主题，以及颈动脉狭窄的调查以及审计和报告CEA结果的作用。研究：对于考虑进行CEA的患者，应获得CT或MRI的脑成像，以记录梗塞并排除大块病变。颈动脉检查始于超声检查，如果结果与随后的结果相符，则应进行高质量的MRA或CT血管造影，可以计划治疗并避免进行导管血管造影。同样可接受的方法是直接从超声检查到导管血管造影，这仍然是颈动脉评估的金标准。适应症：合适的CEA患者是那些由于70-99％的颈动脉狭窄而出现短暂性脑缺血发作或非致残性中风的患者。最大允许中风和死亡率为6％。不确定的CEA候选者是症状性狭窄为50-69％的患者，以及无症状性狭窄>或= 60％的患者，但如果根据其他风险因素（与颈动脉斑块和某些患者特征相关）进行仔细选择，将从手术中受益。仅当可以以极低的重大并发症发生率（3％或更少）进行手术时，无症状患者才会受益。不适当的患者是那些症状少于50％或无症状的狭窄患者少于60％，以及那些医疗或神经疾病状况不稳定的患者。技术：颈动脉内膜切除术可以采用区域麻醉或全身麻醉进行，对于后者，有多种监测技术可用于评估颈动脉交叉钳夹期间的脑灌注。虽然不能认为监测是强制性的，并且没有任何一种监测技术明显优越，但脑电图是最常用的。 “外翻”内膜切除术是外科手术技术的一种变体，并且有一些证据表明，更广泛地应用修补术可减少手术卒中的急性风险和长期复发性狭窄的风险。颈动脉血管成形术和扩张：这种血管内和微创手术的经验不断增长，其技术也在不断发展。一些经验丰富的治疗师已经报告了一系列病例的出色结果，并且目前正在进行将CAS与CEA进行比较的随机试验。但是，此时将CAS纳入常规实践以替代CEA为时尚早。审计：已经证明，对CEA适应症和结果进行审计并定期反馈给手术外科医生可以显着改善该手术的性能。建议在地方和区域级别进行颈动脉内膜切除术审核。

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