最近的进展和有争议的问题,在无症状的动脉狭窄症的最佳管理
Kosmas I Paraskevas1, Martin M Brown2, Brajesh K Lal3
1Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.
Journal of vascular surgery
|November 8, 2023
概括
无症状大脑管狭窄症 (AsxCS) 的最佳管理涉及所有患者的最佳医疗治疗 (BMT). 高风险的个体可能受益于 carotid revascularization 程序,如 carotid endarterectomy (CEA), carotid 动脉支架 (CAS) 或横 carotid 动脉 revascularization (TCAR).
科学领域:
- 血管外科 血管外科
- 神经学 神经学
- 心脏病学 心脏病学
背景情况:
- 无症状大脑管狭窄症 (AsxCS) 的管理仍然存在争议.
- 最近的进展需要对诊断和治疗策略进行更新的审查.
- 本研究更新了2021年关于AsxCS.CS的专家审查和立场声明.
研究的目的:
- 审查最近在AsxCS.诊断和管理方面的进展.
- 为AxxCS患者提供关于最佳治疗策略的最新指导.
- 为了确定高风险的患者子组,他们可能会受益于再血管化.
主要方法:
- 在2023年8月1日之前进行系统文献综述 (PubMed,EMBASE,Scopus).
- 关键词包括:无症状的动脉狭窄,动脉内关节切除术 (CEA),动脉支架 (CAS),跨动脉再血管 (TCAR).
- 涵盖的领域:最佳医学治疗 (BMT),手术/内血管技术,风险因素,成像和认知功能障碍.
主要成果:
- 最好的医疗治疗 (BMT) 对所有AsxCS患者至关重要.
- 高危子组 (例如,严重狭窄≥80%,微血栓,斑块特征) 需要考虑重新血管化 (CEA,CAS,TCAR).
- 目前,将AsxCS与认知功能障碍联系在一起的证据不足.
结论:
- 最佳的AsxCS管理将BMT与针对特定高风险子组的个性化预防性动脉再血管化相结合.
- 治疗决策应整合患者的偏好,临床/成像数据和风险预测模型.
- 未来的研究应该探索AsxCS-认知功能关系和重血管化的影响.
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