颈动脉内膜切除术.ppt

Shunt 是否的判断 TCD 残端压力 EEG 全部选择 快速手术 转流管的选择 Simple Brener Edward Patch -angioplasty Occlusive Carotid 颈动脉支架成形术 Wholey注册研究 2003年；53个中心；11243例患者；12392例颈动脉支架 技术成功率98.9% 围手术期并发症：TIA发作3.07%，卒中3.34%，与手术有关的死亡率 0.64%，与手术无关的死亡率 0.77%, 总的死亡和卒中发作率是4.75% 术后1年、2年和3年再狭窄率 分别是2.7%, 2.6%, 2.4% 术后1年、2年和3年卒中复发的风险在分别是 1.2%, 1.3%, 1.7%。 Wholey MH, Al-Mubarek N.Updated review of the global carotid artery stent registry.Catheter Cardiovasc Interv. 2003 Oct;60(2):259-66 目前已经完成的和正在进行的对比研究 CAVATAS（Endovascular versus surgicaltreatment in patients with carotid stenosis in the Carotid and Vertebral ArteryTransluminal Angioplasty Study） EVA-3S（Carotid angioplasty and stenting with and without cerebralprotection: clinical alert from the Endarterectomy Versus Angioplasty inPatients With Symptomatic Severe Carotid Stenosis） SAPPHIRE（Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy） TESCAS-C（ Trial of Endarterectomy vs Stenting to Carotid Atherovascular Stenosis-China ） CARESS （Carotid Revascularization Endarterectomy versus Stent Trial） SPACE（Stent-Protected Percutaneous Angioplasty of the Carotid versus Endarterectomy;） 颈动脉内膜切除 CEA的历史 CEA循证医学证据 手术治疗 研究热点 CEA的历史 Thomas Willis De Cerebri Anatome 1621-1675 Carotid Stroke cerebral claudication John Ramsay Hunt 1872-1937 Hans Chiari 1851-1906 “It may add to our knowledge of encephalomalacia and the accuracy of vascular localization if the main vessel in the neck is also considered Early Carotid Surgery Miller Fisher 1951，8 Cases Carrea R, Molins M, Murphy G. Surgical treatment of spontaneous thrombosis of the internal carotid artery in the neck: carotid-carotidal anastomosis: report of a case. Acta Neurol Latinoam. 1955;1:71–78 Eastcott HHG, Pickering GW, Rob C. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954;2:994–996 Early CEA RCT CASANOVA NASCET ECST ACAS … … Loftus Atos CEA循证医学证据 颈动脉内膜切除 NASCET（the North American Symptoma