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[TCT2009]Michael R. Jaff教授谈药物治疗重度颈动脉狭窄

作者:国际循环网   日期:2009/9/25 11:42:00

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International Circulation: What is the medical therapy for severe carotid stenosis to reduce large-vessel embolic stroke? 国际循环:请问可以用什么药物治疗重度颈动脉狭窄,以减少大血栓性中风的发生?

International Circulation: What is your advice regarding the treatment of patients with stenosis who are asymptomatic?
国际循环:对于无症状狭窄患者的治疗,您有什么建议?

Prof. Michael R. Jaff:  
These are the groups of patients who have the highest risk for complications.  They are asymptomatic so, automatically, their stroke risk per year is low at 2-3% per year.  So you cannot offer them a procedure that results in a 5% stroke rate because then you cause a greater risk of harm by doing the procedure.  Basically the goal is, if they have less than 80% stenosis, they should be maximally medically treated and have serial carotid ultrasounds to make sure the disease is not getting worse.  Once it is 80%, at least in the United States, the only option you have is endarterectomy by a skilled vascular surgeon or enrolling them in a clinical trial that compares carotid stent and endarterectomy.
Prof. Michael R. Jaff: 这些患者发生并发症的风险最高。他们没有症状,因此每年中风风险自然也低,约为每年2-3%。所以不能提供能导致5%中风率的操作,因为这样做产生危害的风险可能会更大。基本的目标是,如果狭窄小于80%,应最大限度地给予治疗,并进行定期常规颈动脉超声波检查,以明确疾病是否发生恶化。一旦达到80%,至少在美国,唯一的选择是由技术熟练的血管外科医生进行动脉内膜切除术,并且在这种情况下,才与颈动脉支架和动脉切除术具有可比性。

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