山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 11-15.doi: 10.6040/j.issn.1673-3770.1.2020.054

• 眼缺血综合征多学科精准诊疗 专家笔谈 • 上一篇    下一篇

颈动脉狭窄诊疗进展

徐泽勤综述郭连瑞审校   

  1. 徐泽勤 综述 郭连瑞 审校 首都医科大学宣武医院 血管外科/首都医科大学血管外科研究所, 北京 100053
  • 收稿日期:2020-05-28 出版日期:2020-07-20 发布日期:2020-08-28
  • 基金资助:
    北京市卫生健康委员会卫生与健康科技成果与适宜技术推广项目(2018-TG-54)

Advances in the diagnosis and treatment of carotid artery stenosisXU Zeqin Overview GUO Lianrui Guidance Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, ChinaAbstract:

Carotid artery stenosis is a common clinical disorder. Its main clinical symptoms are transient ischemic attacks and cerebral infarction; ocular ischemic syndrome(OIS)is rare. Its diagnostic imaging modalities include doppler ultrasound imaging, CTA, and MRA. Medical therapy, including risk factor management of atherosclerosis, is necessary for all patients with carotid artery stenosis. Carotid revascularization techniques, including carotid endarterectomy or carotid artery stenting, should be performed for asymptomatic patients with severe carotid artery stenosis and symptomatic patients with moderate carotid stenosis. Patients with carotid artery stenosis need early interventions to prevent stroke, improve ocular artery perfusion, and, ultimately, prevent further vision loss.   

  1. 6%, 男性比女性更容易患病[1]。在一些种族中, 如高加索人和美洲原住民中颈动脉狭窄患病风险较高[2]。动脉粥样硬化是导致CAS的最常见原因, 其他导致颈动脉狭窄的病因还包括纤维肌性发育不良、颈部放射治疗、动脉炎和动脉夹层等。
  • Received:2020-05-28 Online:2020-07-20 Published:2020-08-28

摘要: 颈动脉狭窄是临床上常见的疾病,主要的临床症状有一过性脑缺血发作和脑卒中等,罕见的临床症状如眼缺血综合征(OIS)等。在临床上常用的检查方法有颈动脉超声、计算机断层扫描血管造影(CTA)、磁共振血管造影(MRA)、数字减影血管造影成像技术(DSA)等。颈动脉狭窄患者均需要进行包括控制动脉粥样硬化相关危险因素在内的最佳内科治疗;无症状颈动脉重度狭窄患者以及伴有症状的颈动脉中度狭窄患者需要进行手术治疗,主要的手术治疗方法包括颈动脉内膜剥脱术和颈动脉支架成形术。对颈动脉狭窄病变进行早期干预治疗可以降低远期脑卒中发生率,明显改善眼部血流,防止视力进一步下降。

关键词: 颈动脉狭窄, 颈动脉内膜剥脱术, 颈动脉血管成形术, 眼缺血综合征

Abstract: Carotid artery stenosis is a common clinical disorder. Its main clinical symptoms are transient ischemic attacks and cerebral infarction; ocular ischemic syndrome(OIS)is rare. Its diagnostic imaging modalities include doppler ultrasound imaging, CTA, and MRA. Medical therapy, including risk factor management of atherosclerosis, is necessary for all patients with carotid artery stenosis. Carotid revascularization techniques, including carotid endarterectomy or carotid artery stenting, should be performed for asymptomatic patients with severe carotid artery stenosis and symptomatic patients with moderate carotid stenosis. Patients with carotid artery stenosis need early interventions to prevent stroke, improve ocular artery perfusion, and, ultimately, prevent further vision loss.

Key words: Carotid artery stenosis, Carotid artery endarterectomy, Carotid angioplasty, Ocular ischemic syndrome

中图分类号: 

  • R771.3
[1] de Weerd M, Greving JP, Hedblad B, et al. Prevalence of asymptomatic carotid artery Stenosis in the general population: an individual participant data meta-analysis[J]. Stroke, 2010, 41(6): 1294-1297. doi:10.1161/STROKEAHA.110.581058.
[2] Rockman CB, Hoang H, Guo Y, et al. The prevalence of carotid artery Stenosis varies significantly by race[J]. J Vasc Surg, 2013, 57(2): 327-337. doi:10.1016/j.jvs.2012.08.118.
[3] Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery Stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators[J]. N Engl J Med, 2000, 342(23): 1693-1700. doi:10.1056/NEJM2000-06083422302.
[4] Terelak-Borys B, Skonieczna K, Liberek I. Ocular ischemic syndrome-a systematic review[J]. Med Sci Monit, 2012,18(8):138-144. doi: 10.12659/msm.883260.
[5] Sirimarco G, Amarenco P, Labreuche J, et al. Carotid atherosclerosis and risk of subsequent coronary event in outpatients with atherothrombosis[J]. Stroke, 2013, 44(2): 373-379. doi:10.1161/STROKEAHA.112.673129.
[6] 李自超,蔡宏斌,范祯祯,等. MRA与颈部血管彩超诊断颈动脉狭窄的比较[J]. 暨南大学学报(自然科学与医学版),2017,38(2):155-159. doi:10.11778/j.jdxb.2017.02.011. LI Zichao, CAI Hongbin, FAN Zhenzhen, et al. Comparation of MRA with carotid artery ultrasound in patients with carotid atheriosclerosis[J]. Journal of Jinan University(Natural Science & Medicine Edition), 2017, 38(2):155-159. doi:10.11778/j.jdxb.2017.02.011.
[7] Makowski MR, Botnar RM. MR imaging of the arterial vessel wall: molecular imaging from bench to bedside[J]. Radiology, 2013, 269(1): 34-51. doi:10.1148/radiol.13102336.
[8] Chilcote WA, Modic MT, Pavlicek WA, et al. Digital subtraction angiography of the carotid arteries: a comparative study in 100 patients[J]. Radiology, 1981, 139(2): 287-295. doi:10.1148/radiology.139.2.7012921.
[9] MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe(70-99%)or with mild(0-29%)carotid Stenosis. European Carotid Surgery Trialists Collaborative Group[J]. Lancet, 1991, 337(8752): 1235-1243.
[10] North American symptomatic carotid endarterectomy trial. Methods, patient characteristics, and progress[J]. Stroke, 1991, 22(6): 711-720. doi:10.1161/01.str.22.6.711.
[11] Yamauchi K, Enomoto Y, Otani K, et al. Prediction of hyperperfusion phenomenon after carotid artery stenting and carotid angioplasty using quantitative DSA with cerebral circulation time imaging[J]. J Neurointerv Surg, 2018, 10(6): 576-579. doi:10.1136/neurintsurg-2017-013259.
[12] Paraskevas KI, Mikhailidis DP, Veith FJ, et al. Definition of best medical treatment in asymptomatic and symptomatic carotid artery Stenosis[J]. Angiology, 2016, 67(5): 411-419. doi:10.1177/000331971562-4526.
[13] Ma FY, Su J, Shang QL, et al. Changes in ocular hemodynamics after carotid artery angioplasty and stenting(CAAS)in patients with different severity of ocular ischemic syndrome[J]. Curr Eye Res, 2018, 43(2): 266-272. doi:10.1080/02713683.2017.1390771.
[14] 林浩,朱庆斌,倪小佳,等. 中国神经血管手术防治卒中相关指南的系统评价[J]. 中国脑血管病杂志,2018,15(4):169-176. doi:10.3969/j.issn.1672-5921.2018.04.001. LIN Hao, ZHU Qingbin, NI Xiaojia, et al. Systematic review of relevant guidelines for the prevention and treatment of stroke in Chinese neurovascular surgery[J]. Chinese Journal of Cerebrovascular Diseases, 2018,15(4):169-176. doi:10.3969/j.issn.1672-5921.2018.04.001.
[15] Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial[J]. Lancet, 2004, 363(9420): 1491-1502. doi:10.1016/S0140-6736(04)16146-1.
[16] Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized trial of stent versus surgery for asymptomatic carotid Stenosis[J]. N Engl J Med, 2016, 374(11): 1011-1020. doi:10.1056/NEJMoa1515706.
[17] Brott TG, Howard G, Roubin GS, et al. Long-term results of stenting versus endarterectomy for carotid-artery Stenosis[J]. N Engl J Med, 2016, 374(11): 1021-1031. doi:10.1056/NEJMoa1505215.
[18] Cohn EJ Jr, Sandager GP, Benjamin ME, et al. Assessment of ocular perfusion after carotid endarterectomy with color-flow duplex scanning[J]. J Vasc Surg, 1999, 29(4): 665-671. doi:10.1016/s0741-5214(99)70312-5.
[19] Neroev VV, Kiseleva TN, Vlasov SK, et al. Visual outcomes after carotid reconstructive surgery for ocular ischemia[J]. Eye(Lond), 2012, 26(10): 1281-1287. doi:10.1038/eye.2012.118.
[20] Geroulakos G, Botchway LT, Pai V, et al. Effect of carotid endarterectomy on the ocular circulation and on ocular symptoms unrelated to emboli[J]. Eur J Vasc Endovasc Surg, 1996, 11(3): 359-363. doi:10.1016/s1078-5884(96)80086-4.
[21] AbuRahma AF, Mousa AY. Current status of carotid stenting versus endarterectomy[J]. Adv Surg, 2016, 50(1): 235-256. doi:10.1016/j.yasu.2016.04.004.
[22] Ishii M, Hayashi M, Yagi F, et al. Relationship between the direction of ophthalmic artery blood flow and ocular microcirculation before and after carotid artery stenting[J]. J Ophthalmol, 2016, 2016: 2530914. doi:10.1155/2016/2530914.
[23] International Carotid Stenting Study investigators, Ederle J, Dobson J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid Stenosis(International Carotid Stenting Study): an interim analysis of a randomised controlled trial[J]. Lancet, 2010, 375(9719): 985-997. doi:10.1016/S0140-6736(10)60239-5.
[24] Stingele R, Berger J, Alfke K, et al. Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study[J]. Lancet Neurol, 2008, 7(3): 216-222. doi:10.1016/S1474-4422(08)70024-3.
[25] Davis SM, Donnan GA. Carotid-artery stenting in stroke prevention[J]. N Engl J Med, 2010, 363(1): 80-82. doi:10.1056/NEJMe1005220.
[26] 陈忠,杨耀国. 颈动脉狭窄诊治指南[J]. 中国血管外科杂志(电子版),2017,9(3):169-175. doi:10.3969/j.issn.1674-7429.2017.03.003.
[27] Kashyap VS, King AH, Foteh MI, et al. A multi-institutional analysis of transcarotid artery revascularization compared to carotid endarterectomy[J]. J Vasc Surg, 2019, 70(1): 123-129. doi:10.1016/j.jvs.2018.09.060.
[28] de Donato G, Setacci F, Sirignano P, et al. Optical coherence tomography after carotid stenting: rate of stent malapposition, plaque prolapse and fibrous cap rupture according to stent design[J]. Eur J Vasc Endovasc Surg, 2013, 45(6): 579-587. doi:10.1016/j.ejvs.2013.03.005.
[29] Wissgott C, Schmidt W, Brandt-Wunderlich C, et al. Clinical results and mechanical properties of the carotid CGUARD double-layered embolic prevention stent[J]. J Endovasc Ther, 2017, 24(1): 130-137. doi:10.1177/1526602816671134.
[30] Sannino A, Giugliano G, Toscano E, et al. Double layered stents for carotid angioplasty: a meta-analysis of available clinical data[J]. Catheter Cardiovasc Interv, 2018, 91(4): 751-757. doi:10.1002/ccd.27421.
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