颈动脉内膜剥脱术对预防中风所起的作用.pptVIP

LOS/Hospital Charges Mean LOS 26+20 days (10-127d) Mean Operative Charges 13,389+4937 RMB ~ (1,613+595 US $) Mean Total Charges 24,151+2557 RMB ~ (2,909+308 US $) History of CEA in USA First CEA 1954 1960’s – 1980’s improvement in surgical technique and understanding of cerebrovascular disease. History of CEA in USA 1970’s - 80’s Efficacy of CEA questioned 1990’s Randomized trials establish CEA as the treatment of choice for high-grade carotid stenosis over “best medical therapy.” (NASCET ACAS) North American Symptomatic Carotid Endarterectomy Trial (NASCET) 50 centers US Canada (qualified based on 5% morbidity mortality following CEA) Patient symptoms (Low surgical risk): TIA or minor stroke w/in 3 months Lesion classified: 30-69% or 70-99% 659 pts 331 ECASA 328 CEA + ECASA Stopped after 18 mo. Mean f/u secondary to significant advantage of CEA ( stenosis 70% ) NASCET (stenosis 70%) Asymptomatic Carotid Atherosclerosis Study (ACAS) NIH sponsered Asymptomatic patients (low surgical risk) w/ 60% stenosis Angiography not mandatory Angiographic related stroke 1.2 % ACAS History of CEA in USA CEA becomes the “gold standard” for treatment of extra-cranial carotid stenosis. Guidelines for CEA are established. Rate of CEA increases. (200,000 CEA/yr) Indications for CEA Asymptomatic 70 % stenosis 50 % stenosis w/ large ulcer TIA 70 % stenosis 50 % stenosis w/ large ulcer Previous Stroke Stable/Improving neurologic exam 70 % stenosis 50 % stenosis w/ large ulcer Evolving Stroke 70 % stenosis Global Symptoms 70 % stenosis and uncorrectable vertebrobasilar disease AHA Standards for CEA (1989) History of CEA in USA 1990’s Carotid Angioplasty and Stent (CAS) introduced. 2000 Cerebral protection devices introduced and outcomes of CAS appear comparable to CEA. Randomized prospective trial establishes CAS equivalent to CEA in high-risk symptom