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InterventionforAsymptomaticCarotidStenosisshouldbeStratified
罗建方广东省人民医院JianfangLuo,M.D.GuangdongCardiovascularInstituteGuangdongProvincialPeople’sHospital20088
Themechanismofstrokewith
carotidlesionEmboliHypoperfusion Clinicalsymptomscausedbyembolicdiseasein80%ofpatients20%byhemodynamicimpairment20088
PosteriorInferiorCerebellarArteryInternalCarotidArteryVertebralArteryAthroscleroticplaqueThrombusEmbolusOcclusivethrombusCerebralCirculationand
ThromboembolicLesionsWhyshouldtreatcarotidlesion?20088
CarotidArteryDiseasePatientsSymptomaticAsymptomatic25%75%CarotidStenosis20088
SymptomaticCarotidStenosisNaturalHistoryCarotidstenosis+TIARiskofstrokein1styr=12-13%5thyr=30-37% Sundtetal.,1987 Dennisetal.Stroke,199020088
AsymptomaticCarotidStenosisNaturalHistoryStenoses75% riskofstrokein1styr=2-5% Roedereretal.Stroke,1984 Hennerecietal.Brain,198720088
Majorstrokebystenosisseverity20088
Riskofstrokeinpatientswithasymptomaticcarotidstenosishasfallensignificantly.Abbottetal.,InternationalJournalofStroke,2007.20088
ATROCAP:
Atorvastatin20mgStabilizeplaque“Stabilizingplaqueisanimportantmechanismtoreducecardiovascularandcerebralevents.”MeanPercentchange(%)-60-50-40-30-20-100UlcerationInflammationMacrophagePlacebo(n=30)Lipitor20mg(n=29)CortellaroMetal.ThrombHaemost.2002;88:41-47.20088
RiskStratificationofAsymptomaticCarotidStenosisEurJVascEndovascSurgxx,1e10(2008)20088
Plaquemorphology:“HighRisk”20088
“Vulnerable”plaqueincarotidspecimen20088
Lesionmorphologiesincarotidartery20088
PlaqueMorphologyandStrokeRiskUlceration=Iminentstroke riskofstroke= 7.5% Autretetal.Lancet,1987Heterogeneousandulceratedlesions=Risk2-4x Langsfeldetal.JVascSurg,1989 Sterpettietal.Str
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