کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5619561 | 1406075 | 2017 | 38 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Asymptomatic Carotid Artery Stenosis: Revascularization
دانلود مقاله + سفارش ترجمه
دانلود مقاله ISI انگلیسی
رایگان برای ایرانیان
کلمات کلیدی
CASEPDFDACMSTIAOMTMACCECeA - CEAMyocardial infarction - آنفارکتوس میوکاردUnited States Food and Drug Administration - اداره غذا و داروی ایالات متحدهCarotid endarterectomy - اندآرترکتومی کاروتیدCarotid artery disease - بیماری شریانی کاروتیدcarotid artery stenting - ترشح شریان کاروتیدtransient ischemic attack - حمله ایسکمی گذراoptimal medical therapy - درمان بهینه پزشکیembolic protection device - دستگاه محافظ محرکStroke - سکته مغزیTVR - مونو بلوک پر کردن
موضوعات مرتبط
علوم پزشکی و سلامت
پزشکی و دندانپزشکی
کاردیولوژی و پزشکی قلب و عروق
پیش نمایش صفحه اول مقاله
چکیده انگلیسی
In patients with carotid stenosis, the most common cause of stroke is atheroembolization, and the risk is strongly related to stenosis severity and symptomatic status (stroke or transient ischemic attack within 6Â months). Carotid revascularization by carotid endarterectomy (CEA) or carotid artery stenting (CAS) results in plaque “passivation” by lumen enlargement, plaque removal, or plaque coverage with subsequent endothelialization. While there is considerable circumstantial evidence linking a decrease in the risk of stroke to the use of “optimal medical therapy (OMT)”, the components of OMT have not been defined, and such therapy has not been rigorously evaluated in any randomized clinical trial (RCT) compared with revascularization. Studies of other vascular patients suggest that statins decrease the risk of stroke by anti-inflammatory effects, rather than cholesterol reduction. The Carotid Revascularization Endarterectomy versus Stent Trial (CREST-2) is currently randomizing standard-risk patients with asymptomatic severe carotid stenosis to OMT alone versus OMT plus CEA or CAS, but results are not expected until 2020. In the meantime, data from several “landmark” trials of CEA versus aspirin demonstrated 45-65% reduction in the 5-year risk of stroke after CEA. Several RCTs demonstrate superiority of CAS over CEA in high-risk patients (those at high-risk for CEA), and equivalence of CAS and CEA in standard-risk patients (those at acceptable risk for CEA). Compared with CEA, CAS is associated with significantly less periprocedural myocardial infarction, cranial nerve injury, and neurological injury (cranial nerve injury plus stroke); higher risk of minor stroke; and similar risk of long-term stroke. Features that increase the risk of CAS include complex aortic arch and carotid anatomy, and features that increase the risk of CEA include severe underlying cardiopulmonary disease and hostile neck anatomy; age>Â 80Â years, especially those with baseline cognitive impairment, are at higher risk for stroke after CEA and CAS.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Progress in Cardiovascular Diseases - Volume 59, Issue 6, MayâJune 2017, Pages 591-600
Journal: Progress in Cardiovascular Diseases - Volume 59, Issue 6, MayâJune 2017, Pages 591-600
نویسندگان
Robert D. Safian,