支架与手术——神经科专科医生的观点

Stenting versus Surgery — the Neurologist Point of View

尚无充分证据支持血管内治疗可替代动脉内膜切除术而成为治疗颈动脉狭窄的标准疗法。最近的Cochrane系统评价也未发现颈动脉血管内治疗与手术在主要疗效方面存在差异。随机试验的证据表明 ,血管内治疗颈动脉狭窄在避免颅神经病变和创伤性血肿等小的并发症方面有优势。长期随访结果表明 ,两者卒中发病率没有差别 ,但可信区间范围很宽 ,可能包含了这两种治疗方法在风险和获益两方面存在实质差异的概率。应用保护装置的支架术预防脑卒中发生与传统手术相比无差别 ,且还有导致额外并发症的风险。

There was no enough evidence to support the view that endovascular treatment could alternate the endarterectomy to be a standard treatment of carotid stenosis. A recent Cochrane systematic review found no difference in major outcomes between endovascular treatment and surgery. The randomised trials provided data to show that the main advantage of endovascular treatment for carotid artery stenosis was the avoidance of minor complications such as cranial nerve palsy and wound haematoma of surgery. Longer term follow also showed no difference in the rate of stroke during follow up, but the confidence intervals were very wide allowing the possibility of a substantial difference in risk and benefits of the two treatments. There was no difference in avoidance of stroke between carotid stenting using protection devices and surgery, and the protection devices could cause additional complications.