Carotid Artery Stenting for Asymptomatic Carotid Stenosis: What We Need to Know for Treatment Decision.

IF 1.2 Q4 CLINICAL NEUROLOGY
Jang-Hyun Baek
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引用次数: 1

Abstract

A clinical decision on the treatment of asymptomatic carotid stenosis is challenging, unlike symptomatic carotid stenosis. Carotid artery stenting (CAS) has been recommended as an alternative to carotid endarterectomy (CEA) based on the finding that the efficacy and safety of CAS were comparable to CEA in randomized trials. However, in some countries, CAS is often performed more frequently than CEA for asymptomatic carotid stenosis. Moreover, it has been recently reported that CAS is not superior to the best medical treatment in asymptomatic carotid stenosis. Due to these recent changes, the role of CAS in asymptomatic carotid stenosis should be revisited. When determining the treatment for asymptomatic carotid stenosis, one should consider several clinical factors including stenosis degree, patient life expectancy, stroke risk by medical treatment, availability of a vascular surgeon, high risk for CEA or CAS, and insurance coverage. This review aimed to present and pragmatically organize the information that is necessary for a clinical decision on CAS in asymptomatic carotid stenosis. In conclusion, although the traditional benefit of CAS is being revisited recently, it seems too early to conclude that CAS is no longer beneficial under intense and systemic medical treatment. Instead, a treatment strategy with CAS should evolve to select eligible or medically high-risk patients more precisely.

无症状颈动脉狭窄的颈动脉支架植入术:我们需要知道的治疗决策。
与症状性颈动脉狭窄不同,临床决定治疗无症状性颈动脉狭窄具有挑战性。颈动脉支架植入术(CAS)已被推荐作为颈动脉内膜切除术(CEA)的替代方法,因为在随机试验中发现CAS的疗效和安全性与CEA相当。然而,在一些国家,对于无症状的颈动脉狭窄,CAS通常比CEA更频繁。此外,最近有报道称,在无症状的颈动脉狭窄中,CAS并不优于最佳的药物治疗。由于这些最近的变化,CAS在无症状颈动脉狭窄中的作用应该被重新审视。在确定无症状颈动脉狭窄的治疗方法时,应考虑几个临床因素,包括狭窄程度、患者预期寿命、药物治疗的卒中风险、血管外科医生的可用性、CEA或CAS的高风险以及保险范围。这篇综述的目的是提供和实用地组织信息,这些信息对于临床决定是否使用CAS治疗无症状颈动脉狭窄是必要的。综上所述,尽管最近人们重新审视了CAS的传统益处,但现在断定CAS在高强度和系统性的医疗治疗下不再有益似乎还为时过早。相反,CAS的治疗策略应该发展为更精确地选择符合条件或医学上高风险的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
34
审稿时长
12 weeks
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