[无症状患者颈动脉内膜切除术的可取性]。

Q4 Medicine
D A Korshunov, V A Kulbak, A V Chupin
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引用次数: 0

摘要

目的:确定无症状颈动脉狭窄患者的最佳治疗策略:确定无症状颈动脉狭窄患者的最佳治疗策略:作者回顾了1993年至2023年间关于无症状颈动脉狭窄60%-99%患者治疗的临床指南,以及比较无症状患者颈动脉内膜剥脱术和最佳药物治疗的医学研究和荟萃分析:无症状颈动脉狭窄患者治疗策略的选择仍存在争议。20 世纪末,有几项大型随机临床试验对无症状患者的颈动脉内膜切除术和最佳药物疗法进行了比较。然而,药物治疗已经发生了重大变化,这使人们对之前结果的相关性产生了质疑。本综述重点介绍了无症状颈动脉狭窄患者的治疗演变,并介绍了治疗这些患者的现代方法:结论:与最佳药物治疗和每年的脑栓塞风险相比,75 岁以下的患者可从颈动脉内膜切除术中获益,但围术期风险较小。无症状颈动脉狭窄80%-99%的患者由于急性脑血管意外的风险较高,至少在获得更多数据之前,可以选择颈动脉内膜剥脱术。应根据自身经验、患者对治疗的依从性和生活方式的纠正,为特定患者选择最佳策略。ACTRIS(2025年)和CREST-2(2026年)研究的结果有望澄清这一问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Advisability of carotid endarterectomy in asymptomatic patients].

Objective: To determine the optimal treatment strategy for patients with asymptomatic carotid stenosis.

Material and methods: The authors reviewed clinical guidelines for the management of patients with asymptomatic carotid stenosis 60-99%, as well as medical studies and meta-analyses comparing carotid endarterectomy and optimal drug therapy in asymptomatic patients between 1993 and 2023.

Results: The choice of treatment strategy for patients with asymptomatic carotid artery stenosis is still a controversial issue. There were several large randomized clinical trials comparing carotid endarterectomy with optimal medical therapy in asymptomatic patients at the end of the 20th century. However, drug therapy has undergone significant changes calling into question the relevance of previous results. This review highlights the evolution of management of patients with asymptomatic carotid stenosis and also presents modern approaches to the treatment of these patients.

Conclusion: Patients younger 75 years old gain an advantage from carotid endarterectomy with small perioperative risk compared to optimal drug therapy and yearly risk of cerebral embolism. Patients with asymptomatic carotid stenosis 80-99% are candidates for carotid endarterectomy due to higher risk of acute cerebrovascular accident at least until more data are available. The choice of the best tactics for a particular patient should be made individually depending on own experience and patient's adherence to therapy and lifestyle correction. The results of the ACTRIS (2025) and CREST-2 (2026) studies are expected to clarify this issue.

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来源期刊
Khirurgiya
Khirurgiya Medicine-Medicine (all)
CiteScore
0.70
自引率
0.00%
发文量
161
期刊介绍: Хирургия отдельных областей сердце, сосуды легкие пищевод молочная железа желудок и двенадцатиперстная кишка кишечник желчевыводящие пути печень
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