颅外颈动脉急性病变的诊断和处理

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
Rodolfo Pini , Enrico Gallitto , Sara Fronterrè , Cristina Rocchi , Marcello Lodato , Betti Shyti , Gianluca Faggioli , Mauro Gargiulo
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引用次数: 0

摘要

症状性颈动脉狭窄和颈动脉夹层是决定短暂性脑缺血发作或中风的颅外脑血管的急性情况。医疗、外科或血管内治疗是治疗这些疾病的不同选择。这篇叙述性综述的重点是从症状到治疗的颅外脑血管急性疾病的管理,包括颈动脉血运重建后卒中。短暂性脑缺血发作或中风的症状性颈动脉狭窄(根据北美症状性颈动脉粥样硬化内膜切除术试验标准,>;50%)在症状出现后2周内受益于颈动脉血运重建,主要是与药物治疗相关的颈动脉内膜切除术,以降低中风复发的风险。与急性颅外颈动脉夹层不同,抗血小板或抗凝治疗可以预防新的神经缺血性事件,只有在症状复发的情况下才考虑支架植入。颈动脉血运重建后的中风可能与以下病因有关:颈动脉操作、斑块碎裂或夹闭性缺血。因此,颈动脉血运重建后神经事件的原因和时间会影响医疗或外科治疗。颅外脑血管的急性情况包括一组异质性的病理,正确的治疗可以显著减少症状复发。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnosis and management of acute conditions of the extracranial carotid artery

Symptomatic carotid stenosis and carotid dissection are acute conditions of extracranial cerebrovascular vessels determining transient ischemic attack or stroke. Medical, surgical, or endovascular management are different options to treat these pathologies. This narrative review focused on the management, from symptoms to treatment, of the acute conditions of extracranial cerebrovascular vessels, including post–carotid revascularization stroke. Symptomatic carotid stenosis (> 50% according to North American Symptomatic Carotid Endarterectomy Trial criteria) with transient ischemic attack or stroke benefits from carotid revascularization—primarily with carotid endarterectomy associated with medical therapy—within 2 weeks from symptom onset to reduce the risk of stroke recurrence. Different from acute extracranial carotid dissection, medical management with antiplatelet or anticoagulant therapy can prevent new neurologic ischemic events, considering stenting only in case of symptom recurrence. Stroke after carotid revascularization can be associated with the following etiologies: carotid manipulation, plaque fragmentation, or clamping ischemia. Medical or surgical management is therefore influenced by the cause and timing of the neurologic events after carotid revascularization. Acute conditions of the extracranial cerebrovascular vessels include a heterogeneous group of pathologies and correct management can reduce symptom recurrence substantially.

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来源期刊
CiteScore
7.20
自引率
4.30%
发文量
567
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