颈动脉狭窄是美国血管专家治疗的最常见诊断之一。颈动脉狭窄的最佳治疗仍存在争议,然而,围绕诊断成像模式的显着变化,纵向监视,医学治疗,和程序性干预。来自高质量随机对照试验和观察性研究的数据构成了当前管理范式和指导临床实践的社会指南的基础。目前,颈动脉疾病的诊断通常通过双工超声和根据需要使用计算机断层扫描或磁共振血管造影进行补充横断面成像来确定,以提供额外的解剖信息.所有有记录的闭塞性疾病的患者应接受目标导向的药物治疗,包括抗血小板药物和降脂策略。最常见的是他汀类药物。患有严重颈动脉狭窄且预期寿命可接受的患者可考虑进行颈动脉血运重建。程序学家应最佳地考虑共享决策方法,其中可以与患者仔细考虑血运重建的权衡,以优化知情的治疗决策。在目前的实践中,有三种不同的手术选择来治疗颈动脉狭窄,包括颈动脉内膜切除术,经股颈动脉支架置入术,经颈动脉血管重建术.应该指出的是,每个程序,尽管在大多数临床环境中经常互换使用,携带技术细微差别和结果差异。在这次审查中,我们对这些主题中的每一个进行了探讨,并概述了针对无症状颈动脉狭窄患者的适当治疗方法。
Carotid artery stenosis is one of the most common diagnoses treated by vascular specialists in the United States. The optimal management of carotid stenosis remains controversial, however, with notable variation surrounding diagnostic imaging modalities, longitudinal surveillance, medical therapies, and procedural interventions. Data from high-quality randomized controlled trials and observational studies form the foundation for current management paradigms and societal guidelines that inform clinical practice. Presently, a diagnosis of carotid disease is most often established with duplex ultrasound and supplemental cross-sectional imaging using computed tomography or magnetic resonance angiography as needed to provide additional anatomic information. All patients with documented occlusive disease should receive goal-directed medical therapy with antiplatelet agents and a lipid-reduction strategy, most commonly with a statin. Those with severe carotid stenosis and an acceptable life expectancy may be considered for carotid artery revascularization. The proceduralist should optimally consider a shared decision-making approach in which the tradeoffs of revascularization can be carefully considered with the patient to optimize informed therapeutic decision making. In current practice, three distinct procedure options exist to treat carotid artery stenosis, including carotid endarterectomy, transfemoral carotid artery stenting, and transcarotid artery revascularization. It should be noted that each procedure, although often used interchangeably in most clinical settings, carry technical nuances and outcome disparities. In this review, each of these topics are explored and various approaches are outlined surrounding the appropriate use of treatments for patients with asymptomatic carotid artery stenosis.