Asymptomatic Carotid Stenosis in Cardiac Surgery Patients: Is Less More?
Asymptomatic Carotid Stenosis in Cardiac Surgery Patients: Is Less More?
复制标题
心脏手术患者的无症状颈动脉狭窄：少还是多？
DOI：
10.1161/strokeaha.117.018754
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发表时间：
2017
期刊：
影响因子：
8.3
通讯作者：
Gottesman,RebeccaF
中科院分区：
文献类型：
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作者：
Gottesman,RebeccaF
随着需要进行冠状动脉搭桥手术的人群年龄和合并症的增加，无症状颈动脉狭窄在手术候选者中可能会变得越来越普遍。使用瑞典登记数据，对 1987 年至 2006 年间接受孤立 CABG 的个体的危险因素进行评估，结果表明，糖尿病发病率增加了一倍多，高血压和既往中风的发病率几乎增加了两倍。 10 其他研究报告称，与早期接受心脏手术的个体相比，最近接受手术的人群颈动脉狭窄的发生率更高。 11 因此，了解如何管理 CABG 候选者的无症状颈动脉疾病将变得越来越重要。 CABACS 试验的数据，包括仍在收集的长期随访数据，结合 CREST-2 和其他评估普通人群无症状颈动脉狭窄管理的试验的证据，将有助于指导临床医生规划 CABG 或治疗需要 CABG 的无症状颈动脉狭窄患者。对于需要体外循环手术的个体的无症状颈动脉狭窄的治疗，可能是少即是多。
As the population requiring CABG surgery increases in age and comorbidities, it is likely that asymptomatic carotid stenosis will become increasingly prevalent among surgical candidates. Using Swedish registry data, evaluation of risk factors in individuals getting isolated CABG from 1987 to 2006 demonstrated that the rate of diabetes mellitus more than doubled, and the rates of hypertension and prior stroke nearly tripled. 10 Other studies have reported higher rates of carotid stenosis in more recent surgical cohorts compared with individuals undergoing cardiac surgery in earlier time epochs. 11 Thus, it will become increasingly important to know how to manage asymptomatic carotid disease in CABG candidates. Data from the CABACS trial, including its long-term followup data that are still being collected, in combination with evidence from CREST-2 and other trials evaluating asymptomatic carotid stenosis management in the general population, will help guide clinicians planning CABG, or treating asymptomatic carotid stenosis patients who are in need of CABG. About management of asymptomatic carotid stenosis in individuals requiring cardiopulmonary bypass surgery, it may be that less is more.