无症状的颈动脉狭窄的介入治疗应该分情况对待英文ppt课件.ppt

2008 ATROCAP研究以直接证据证实，立普妥能够减少颈动脉壁炎症，稳定颈动脉斑块。 ATROCAP研究是一项随机、双盲、安慰剂对照研究，入选59名双侧颈动脉狭窄，准备分两步作颈动脉内膜切除术的患者，对切除标本进行组化分析，两次手术间患者接受立普妥20mg或安慰剂治疗，平均治疗4.5个月。结果显示，立普妥20mg可以减少斑块表面溃疡、减少炎症和巨噬细胞，从而稳定斑块，减少斑块破裂机会，稳定斑块是他汀减少血管事件，预防卒中的重要机制之一。 * 需要对无症状性颈动脉狭窄进行危险分层以明确真正高危病人。 * The selection of patients for many vascular interventions has largely been based on the severity of luminal narrowing. However, histological data from the coronary and carotid circulations suggest that other plaque features such as inflammation and fibrous cap thickness may be more important in predicting future thrombo-embolic events. * Thin-cap fibroatheroma ‘‘vulnerable’’ plaque in a carotid endarterectomy specimen. (A) Low-power image, showing a carotid plaque with a relatively larger necrotic core (NC) covered by a thin fibrous cap (FC). An area of calcified necrotic core (*) is seen in the deeper intimal layers. (B) Higher-power image of an area represented by the black box inA, showing the necrotic core and thin fibrous cap infiltrated by foam cells. (C) NumerousCD-68 positive macrophages (MACF) seen infiltrating the fibrous cap. (A and B, Movat pentachrome staining.) * 如果发现溃疡斑块，提示即将发生卒中，其年度卒中风险达7.5% 颈动脉异质性斑块以及溃疡病灶风险增加2～4倍 这些证据提示斑块的形态学对卒中风险的影响巨大。 * * GDPPH, JF Luo 《规范》及指导原则适用于食品药品监管部门对第三类医疗器械批发/零售经营企业经营许可（含变更和延续）的现场核查，第二类医疗器械批发/零售经营企业经营备案后的现场核查，以及医疗器械经营企业的各类监督检查 * Intervention for Asymptomatic Carotid Stenosis should be Stratified  罗建方 广东省人民医院 Jianfang Luo, M.D. Guangdong Cardiovascular Institute Guangdong Provincial People’s Hospital The mechanism of stroke with carotid lesion Emboli Hypoperfusion Clinical symptoms caused by embolic disease in 80% of patients 20% by hemodynamic impairment 2008 Posterior Inferior Cerebellar Artery Internal Carotid Artery Vertebral Artery Athrosclerotic plaque Thrombus Embolus Occlusive thrombus Cerebral Circulation andThromboembolic Lesions Why should treat carotid lesion？ Carotid Artery Disease Patients Symptomatic Asymptomatic 25% 75% Carotid Stenosis