無癥狀的頸動(dòng)脈狹窄的介入治療應(yīng)該分情況對(duì)待-英文課件

1、Intervention for Asymptomatic Carotid Stenosis should be Stratified 羅建方 廣東省人民醫(yī)院Jianfang Luo, M.D.Guangdong Cardiovascular InstituteGuangdong Provincial Peoples Hospital20088The mechanism of stroke with carotid lesion Emboli Hypoperfusion Clinical symptoms caused by embolic disease in 80% of patients

2、 75%risk of stroke in 1st yr = 2-5% Roederer et al. Stroke, 1984 Hennereci et al. Brain, 198720088Major stroke by stenosis severity20088Risk Stratification of Asymptomatic Carotid StenosisEur J Vasc Endovasc Surg xx, 1e10 (2008)20088Plaque morphology：“High Risk” 20088“Vulnerable” plaque in carotid s

3、pecimen20088Revascularization for Asymptomatic Carotid StenosisStratification Strategy20088 頸動(dòng)脈狹窄的治療方法 1藥物治療 （Medical Therapy）2頸動(dòng)脈內(nèi)膜剝離術(shù) （Carotid Endarterectomy, CEA）3經(jīng)皮頸動(dòng)脈支架植入術(shù) （Carotid Artery Stenting, CAS） 20088The Cochrane Collaboration 2006 ASA 200620088Step 1 ：High Risk of StrokeSevere Carotid

4、Stenosis （80%） +Unfavorable Plaque Features （ulceration or heterogenecity ）20088High risk for intervention20088Any 2 of the following = High RiskAGE 80Cerebral ReserveExcessive TortuosityHeavy concentric calcificationCriteria of High Risk Carotid Stenting20088Proposed New ParadigmCarotid Revascularization Indicated?YesNoHigh Stent RiskYesNoMedical ManagementSurveillanceCEA if low riskCarotid StentNeed goo