Experts think that it would be desirable to forgo stenting and endarterectomy in low-risk asymptomatic patients of carotid artery stenosis to spare patients from procedures that may be unnecessary. Data from both randomized trials and nonrandomized studies suggest that the annual rate of stroke among medically treated asymptomatic patients has declined over the past two decades, regardless of the severity of stenosis at baseline. Evidence now suggests that the annual rate of ipsilateral stroke may be as low as 0.5 to 1%, very similar to that observed after successful stenting or endarterectomy. Outside clinical trials, endarterectomy and stenting should be reserved for patients with symptomatic severe stenosis or for asymptomatic patients who are shown to be at higher risk for stroke with medical therapy than with intervention. Such patients (approximately 10 to 15% of patients with asymptomatic stenosis of 70 to 99%) may be identified by an algorithm that incorporates information about microemboli detected by means of transcranial Doppler and in the future by imaging strategies that identify the vulnerable plaque. Source: http://www.nejm.org/
专家认为，低风险的无症状颈动脉狭窄患者最好放弃支架置入和动脉内膜切除，这些可能是不必要的措施。来自随机试验和非随机研究数据表明，过去二十年来，无论基线狭窄的严重程度，药物治疗无症状患者的年卒中率在下降。现有证据提示同侧年卒中率可以低到0.5％至1％，与成功的支架或动脉内膜切除术后观察到的非常相似。临床试验除外，动脉内膜切除术和支架置入术应保留给有症状的严重狭窄患者或证明药物治疗比干预措施中风的风险更高的无症状患者。这样的患者（约占无症状且狭窄70〜99％患者的10至15％）可以通过经颅多普勒检测微栓子信息及将来通过成像手段确定易损斑块加以籈别。来源：http://www.nejm.org/