无症状动脉狭窄症的医疗管理和再血管化
Thomas G Brott1, George Howard2, Brajesh K Lal3
1Department of Neurology, Mayo Clinic, Jacksonville, FL.
The New England journal of medicine
|November 21, 2025
概括
对于无症状的动脉狭窄,动脉支架显著降低了中风风险,与单独的医疗管理相比. 在这组患者中,动脉内关节切除术没有显著的益处,而不是密集的医疗治疗.
科学领域:
- 神经学 神经学
- 血管外科 血管外科
- 临床试验 临床试验
背景情况:
- 医疗治疗,动脉支架和关节切除术的进步需要重新评估无症状动脉狭窄症的管理.
- 再血管化加密医疗管理与单独医疗管理的比较好处仍然不清楚.
研究的目的:
- 为了比较冠状动脉支架加密医疗管理对高度无症状冠状动脉支架加密医疗管理单独对高度无症状冠状动脉支架的疗效.
- 为了比较 carotid endarterectomy 加上密集医疗管理的疗效,与单独的密集医疗管理对高度无症状大脑动脉狭窄的疗效.
主要方法:
- 两项并行,观察者盲目的临床试验,在155个中心招募了患有高度 (≥70%) 无症状大脑动脉狭窄症的患者.
- 主要结局是中风或44天内死亡的组合,或多达4年的ipsilateral缺血性中风.
主要成果:
- 在支架试验中,支架加医疗管理的4年事件率为2.8%,仅医疗管理为6.0% (P=0.02).
- 在关节切除试验中,在4年内,关节切除加上医疗管理时,事件发生率为3.7%,仅仅医疗管理时为5.3% (P=0.24).
- 与44天内医疗治疗组相比,支架和内关节切除组的外科中风/死亡率更高.
结论:
- 动脉支架,当添加到密集医疗管理,显著降低了中风或死亡的风险在高度无症状动脉狭窄的患者.
- 在这种患者群体中,动脉内关节切除术没有显示出与单独的密集医疗管理相比的显著益处.
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