无症状的颈动脉狭窄的入治疗应该分情况对待-英文课件.pptVIP

Intervention for Asymptomatic Carotid Stenosis should be Stratified  罗建方 广东省人民医院 Jianfang Luo, M.D. Guangdong Cardiovascular Institute Guangdong Provincial People’s Hospital The mechanism of stroke with carotid lesion Cerebral Circulation andThromboembolic Lesions Carotid Stenosis Symptomatic Carotid Stenosis Natural History Carotid stenosis + TIA Risk of stroke in 1st yr = 12-13% 5th yr = 30-37% Sundt et al., 1987 Dennis et al. Stroke, 1990 Asymptomatic Carotid Stenosis Natural History Stenoses 75% risk of stroke in 1st yr = 2-5% Roederer et al. Stroke, 1984 Hennereci et al. Brain, 1987 Major stroke by stenosis severity Risk of stroke in patients with asymptomatic carotid stenosis has fallen significantly. ATROCAP： Atorvastatin 20mg Stabilize plaque Risk Stratification of Asymptomatic Carotid Stenosis Plaque morphology：“High Risk” “Vulnerable” plaque in carotid specimen Lesion morphologies in carotid artery Plaque Morphology and Stroke Risk Ulceration = Iminent stroke risk of stroke = 7.5% Autret et al. Lancet, 1987 Heterogeneous and ulcerated lesions = Risk 2-4 x Langsfeld et al. J Vasc Surg, 1989 Sterpetti et al. Stroke, 1988 What we know now The risk of stroke is relevant to severity of stenosis Histological data from the coronary and carotid circulations suggest that other plaque features may be more important in predicting future thrombo-embolic events. Revascularization for Asymptomatic Carotid Stenosis Stratification Strategy The Cochrane Collaboration 2006 ASA 2006 Step 1 ：High Risk of Stroke Severe Carotid Stenosis （≥80%） + Unfavorable Plaque Features （ulceration or heterogenecity ） Step 2 ：High Risk for Stenting High risk Patients 80 y of age (asymptomatic) Access problems Baseline large neurological defect Marked cerebral atrophy + microangiopathy Dementia