颅外段颈动脉狭窄手术时机的研究进展  

Progress in the study of the surgery timing of extracranial carotid stenosis

作　　者：余翀[1] 周斌[1] 李毅清[2] Yu Chong1, Zhou Bin1, LI Yiqing2(1. Department of Vascular Surgery, Shanghai East Hospital, Shanghai 200120, China; 2.Department of Vascular Surgery, the Union Hospital, Wuhan 430074, Chin)

机构地区：[1]上海同济大学附属东方医院血管外科,上海200000 [2]武汉协和医院血管外科,武汉430074

出　　处：《血管与腔内血管外科杂志》2017年第4期880-884,共5页Journal of Vascular and Endovascular Surgery

摘　　要：颅外段颈动脉狭窄的外科干预时机是近几年相关领域争议的热门话题。颈动脉内膜切除术(CEA)是治疗颅外段颈动脉粥样硬化的金标准,虽然美国心脏协会(American Heart Association,AHA)、欧洲血管外科学会(European Society for Vascular Surgery,ESVS)等国际权威指南已经推荐将最佳的CEA时机从首次卒中症状发生后4~6周提前至2周,但是现有不少证据显示超急性期CEA(48 h内)具有更好预防卒中复发的效果且不明显增加围手术期卒中和死亡的风险,建议手术时机进一步提前,而对接受静脉溶栓后CEA手术时机的把握,目前仍无定论。在预防和治疗脑梗死方面,虽然颈动脉支架成形术(CAS)与CEA的总体效果相当,但是早期CAS的安全性不确切,需要更多有力证据支持。目前国内卒中的早期外科干预理念尚未被广泛接受,本文对卒中后早期CEA/CAS干预时机进行综述,以期在各专科医生协作下,选择最佳的干预时机,获得最好的疗效。The timing of the surgical intervention of the extracranial carotid stenosis is a hot topic in related fields in recent years and is still in dispute. Carotid endarterectomy（CEA） is the gold standard to treat extracranial carotid atherosclerosis, although the international authoritative guidelines have adjusted the optimal timing of CEA from 4-6 weeks to 2 weeks after the onset of symptom of stroke, recently, a lot of existing evidence showed that very urgent CEA（48 hours） can effectively prevent the recurrence of stroke, and at the same time doesn＇t significantly increase the perioperative risk of stroke and death, leading the trend to perform CEA even earlier. In addition, the optimal timing of CEA combined with intravenous thrombolysis is still inconclusive. Although studies have shown that the overall outcomes of CEA and carotid artery stenting（CAS） in prevention and treatment of cerebral infarction were almost equal, but the safety of early CAS is not exact, it needs more powerful evidence to support. Currently, the concept of early surgical intervention after stroke has not been widely accepted in China, the author tries to review the timing of CEA/CAS after stroke, hoping that with the cooperation of medical specialists from different related departments, timely and accurate assessment of nervous system function in patients can be made, so that doctors can choose the optimal timing of surgical intervention and achieve the best curative effect.

关 键 词：颈动脉狭窄 外科干预 颈动脉内膜切除术 颈动脉支架成形术 手术时机 

分 类 号：R543.5[医药卫生—心血管疾病]