颈动脉狭窄RCT结果解读.ppt

* Conclusion: EVA-3S- patients with symptomatic, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. CREST- higher risk of stroke with stenting and MI with CEA However, something will be happened like this: In Stent Restenosis In Stent Restenosis Re PTA ?? Interposition ?? Restenosis on Carotid Thanks for your attention! * * * * * * * * * * * * * * * * * Kerber et al. 1980 Theron et al. 1987 48 pts, 4.1% serious morbidity Gil-Peralta et al. 1996 82 pts, 0% mortality, 4.9% morbidity * 颈动脉狭窄的RCT结果解读 樊雪强 叶志东 刘鹏 中日友好医院心血管外科 Carotid stenosis is present in 75% of men and 62% of women 65 years OLeary DH, Polak JF, Kronmal RA, et al. Stroke 1992; 23: 1752-60 According to the American Heart Association and American Stroke Association 170,000 CEA are performed annually in the USA The risk of developing stroke within 90 days of a transient ischemie event (TIA) is 10.5 %. The mortality rate of Cardiovascular and Cerebrovascular disease was NO 1 in 2008. Johnston SC, Gress DR, Browner WS, Sidney S. JAMA 2000;284:2901 -6. WoIfPA, DAgostino RB, Kannel WB, et al. JAMA 1988;259:1025-9. The Importance of the Carotid Artery Disease History of Carotid SurgeryCarotid Angiogarphy 1927 Egas Moniz History of Carotid SurgeryExtracranial artery disease – Intracranial lesion James Hunt 1914 Miller Fisher 1951 History of Carotid SurgeryCarotid Endarterectomy Famous clinical trials for CEA Symptomatic Pts Yrs CEA Drugs NASCET 1988 2226 3 9% 26% ESCT 1981 3024 6.1 10.3% 16.8% Asymptomatic Pts Yrs CEA Drugs ACAS 1989 1662 3 5.1% 11% ACST 1993 3120 5 10 3.8% 11% Indications of CEA for symptomatic patients (NASCET, ECST) ischemic cerebral symptoms TIA amaurosis fugax minor stroke ICA stenosis 50% periprocedural stroke and death rate 6% North Amer