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Clinical considerations in the management of asymptomatic carotid artery stenosis

机译：治疗无症状性颈动脉狭窄的临床考虑

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Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. Moreover, while earlier studies compared carotid endarterectomy and medical therapy, in the past years, a new therapeutic modality, carotid artery angioplasty and stenting, has emerged as a possible alternative. This has been evaluated in a recent randomized controlled trial, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which compared carotid endarterectomy with angioplasty and stenting in both symptomatic and asymptomatic patients. The following review summarizes current knowledge of the natural history, diagnosis, and treatment strategies to counsel patients with asymptomatic carotid artery stenosis.
机译：偶然发现给主治医师带来了相当大的管理难题，并给相应患者带来了心理负担。随着人口老龄化，将有更多患者被诊断为无症状的颈内动脉狭窄。必须根据患者的个人风险状况以及专业人员从大型随机对照试验中获得的循证数据知识，就治疗方案向患者提供咨询。在任何随机对照试验之前，对于无症状性颈动脉狭窄的患者，长期以来缺乏治疗共识。此外，根据从随机对照试验中获得的知识，可能难以评估个人的风险状况。此外，尽管较早的研究比较了颈动脉内膜切除术和药物治疗，但在过去几年中，出现了一种新的治疗方法，即颈动脉血管成形术和支架置入术。在最近的一项随机对照试验“颈动脉血运重建术与支架试验”（CREST）中对此进行了评估，该试验对有症状和无症状患者的颈动脉内膜切除术与血管成形术和支架置入术进行了比较。以下评论总结了当前的自然病史，诊断和治疗策略知识，可为无症状性颈动脉狭窄患者提供咨询。

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