ASYMPTOMATIC CAROTID ARTERY STENOSIS

本提案是一项前瞻性、多中心 预防TIA的药物/手术治疗的随机临床试验， 无症状颈总动脉球狭窄患者的卒中 和/或颈内动脉窦-超过90%的 血流动力学显著颈动脉粥样硬化。 主要目标 该研究的目的是确定是否增加颈动脉内膜切除术 阿司匹林（325 mg）+最佳药物管理将降低 短暂性脑缺血发作与无症状脑梗死的血流动力学关系 严重颈动脉狭窄。 次要目标是确定：（1） 颈动脉瘤手术成功率与复发率 颈动脉内膜切除术后狭窄，（2）进展率（或 药物治疗组中颈动脉粥样硬化的消退）， 在对照颈动脉系统，（3）冠状动脉的发病率 动脉事件（心绞痛、非致死性和致死性心肌梗死） 在后续行动中。 质量保证是研究设计的主要组成部分。 北美症状性颈动脉内膜切除术试验的结果 已经证明颈动脉内膜切除术是治疗的选择 症状性颈动脉狭窄超过70% 据估计 有症状的亚组仅占 颈动脉狭窄 因此，更迫切需要确定 类似的结果是否适用于无症状患者。

This proposal is for a continuation of a prospective, multicenter randomized clinical trial of medical/surgical therapy to prevent TIA and stroke in asymptomatic patients with stenosis of the common carotid bulb and/or internal carotid sinus -- the site of more than 90% of hemodynamically significant carotid artery atherosclerosis. The major aim of the study is to determine whether the addition of carotid endarterectomy to aspirin (325 mg) + best medical management will reduce the incidence of TIA and cerebral infarction in asymptomatic patients with hemodynamically significant carotid stenosis. Secondary objectives are to determine: (1) the surgical success in lesion removal and incidence of recurrent carotid stenosis following carotid endarterectomy, (2) the rate of progression (or regression) of carotid atherosclerosis in the medically treated group and in the control carotid arterial system, and (3) the incidence of coronary artery events (angina pectoris, non-fatal and fatal myocardial infarction) during follow-up. Quality assurance is a major component in study design. The results of the North American Symptomatic Carotid Endarterectomy Trial have demonstrated that carotid endarterectomy is the treatment of choice for symptomatic carotid artery stenosis exceeding 70%. It is estimated that the symptomatic subset represents only 10% of the prevalence of carotid stenosis. Therefore, it is all the more urgent to determine whether similar results apply to asymptomatic patients.