Carotid Surgery Versus Medical Therapy in Asymptomatic Carotid Stenosis
Carotid Surgery Versus Medical Therapy in Asymptomatic Carotid Stenosis
复制标题
无症状颈动脉狭窄的颈动脉手术与药物治疗
作者：
L. Wilkins
背景和目的CASANOVA研究（颈动脉狭窄伴无症状狭窄：手术与阿司匹林）是一项多中心试验，纳入410例颈内动脉无症状狭窄（50-90%）患者，这些患者在血管造影术后随机分组。方法A组206例单侧和双侧狭窄患者，分别行单侧或双侧手术。在B组中，160例单侧狭窄的患者未进行初次手术，而双侧狭窄的患者在患侧进行手术。如果发生以下事件之一，则在3年随访期间对患者进行手术：狭窄超过90%，双侧颈内动脉狭窄超过50%（在更受影响的一侧进行手术）;颈内动脉供血区域的短暂性脑缺血发作，以及该动脉的狭窄大于50%; A组手术侧对侧颈内动脉狭窄大于50%或再狭窄大于50%。所有患者均给予乙酰水杨酸330 mg和双嘧达莫75 mg，每日3次。最短随访时间为3年。终点为缺血性神经功能缺损超过24小时或因手术或卒中死亡。结果共行颈动脉内膜切除术334例。包括血管造影和手术并发症（6.9%）。统计分析发现两组之间的神经功能缺损和死亡人数没有显着差异。结论：对于颈内动脉狭窄小于90%的无症状患者，目前不建议进行颈动脉内膜切除术，除非作为对照临床试验的一部分。然而，较高级别狭窄（>90%）的病例被排除在本研究之外，并被转诊进行手术。关于动脉内膜切除术在这些高风险类别中的潜在受益，无法得出结论。
Background and Purpose The CASANOVA study (Carotid Artery Stenosis with Asymptomatic Narrowing: Operation Versus Aspirin) is a multicenter trial in 410 patients with asymptomatic stenosis (50-90%) of the internal carotid artery who were randomized after angiography. Methods In group A, 206 patients with unilateral and bilateral stenosis had surgery unilaterally or bilaterally, respectively. In group B, 160 patients with unilateral stenosis had no initial surgery, whereas those with bilateral stenosis had surgery on the more affected side. Patients were operated on during the 3-year follow-up period if one of the following events occurred: development of a stenosis exceeding 90% development of a bilateral internal carotid artery stenosis greater than 50% (operation on the more affected side); transient ischemic attack in the region supplied by the internal carotid artery, together with a stenosis of this artery greater than 50%; development of an internal carotid stenosis greater than 50% contralateral to the operated side or restenosis greater than 50% in group A. All patients were treated with 330 mg acetylsalicylic acid and 75 mg dipyridamole three times daily. The minimal follow-up was 3 years. End points were ischemic neurologic deficit exceeding 24 hours or death due to surgery or stroke. Results Altogether, 334 carotid endarterectomies were performed. Complications of angiography and operation (6.9%) were included. Statistical analysis found no significant difference in the number of neurologic deficits and deaths between the two groups. Conclusions Carotid endarterectomy for asymptomatic patients with a stenosis of the internal carotid artery of less than 90% is not recommended at this time except as part of a controlled clinical trial. However, cases of higher grade stenosis (>90%) were excluded from this study and were referred for operation. No conclusion can be rendered regarding the potential benefit of endarterectomy in these higher risk categories.
颈动脉内膜切除术治疗无症状动脉粥样硬化的随机前瞻性试验的研究设计。
影响因子：
8.3
作者：
通讯作者：
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影响因子：
8.3
作者：
ROEDERER, GO;LANGLOIS, YE;STRANDNESS, DE
通讯作者：
STRANDNESS, DE