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【medical-news】颈动脉粥样硬化的治疗

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Clearing clogged arteries in the neck

Balloon angioplasty is getting better at unblocking carotid arteries, but surgery still has the edge.

Opening a blocked heart artery with a balloon and then propping it open with a wire-mesh stent has become a near-equal partner with bypass surgery for restoring blood flow to the heart. Although coronary angioplasty plus stenting isn't quite as durable as bypass surgery, it is much easier on the body, since it doesn't require opening the chest. Giving up a tiny bit of effectiveness for a much shorter recovery is an excellent trade-off for some people.

The situation is different in the carotid arteries, which convey oxygen-rich blood to the brain. In that territory, carotid angioplasty plus stenting (CAS) hasn't quite proved itself to be the equal of endarterectomy, an operation to clean out a clogged carotid artery. Results from one long-awaited clinical trial showed that CAS is nearly as safe and effective as carotid endarterectomy when done by an expert, while results from a second trial indicate that surgery is still the best bet for most people.

An often-silent disease

The right and left carotid arteries branch off the aorta soon after it emerges from the heart and run up to the brain along either side of the neck. These vitally important arteries are prone to atherosclerosis, the damaging process that clogs arteries in the heart, kidneys, legs, and elsewhere.

A buildup of plaque in the carotids usually goes unnoticed. Sometimes it is discovered when a doctor hears "bruits" (BROO-ee) through a stethoscope in one or both carotid arteries. These soft, whooshing sounds are caused by turbulence as blood tumbles through a narrowing in a carotid artery. Clogged carotids are sometimes found during ultrasound exams of the neck and head. For most people, though, the first sign of trouble is a transient ischemic attack or a stroke.

Just as a heart attack is the big worry with cholesterol-clogged coronary arteries, brain attack (stroke) is the main hazard of plaque-narrowed carotid arteries. Plaque in a carotid artery can cause a stroke by restricting blood flow to part of the brain, or by breaking loose and completely blocking a smaller vessel in the brain.

Clearing a carotid artery

Endarterectomy removes fatty plaque through an incision in the neck. Angioplasty plus stenting opens the narrowing from the inside with a balloon and leaves behind a stent to hold the artery open.

Opening a clogged carotid

There are two main ways to open a narrowed carotid artery.

Endarterectomy involves physically removing plaque from inside the carotid artery. A surgeon makes an incision in the neck to expose the artery, clamps the artery, then opens it lengthwise in the region of the narrowing. After scraping the fatty plaque out of the artery, the surgeon enlarges the artery with a diamond-shaped patch, stitches the artery together, then closes the skin of the neck.

Carotid angioplasty begins with a small incision into the femoral artery in the groin. A thin tube called a catheter is gently pushed into the artery and maneuvered up through the aorta into the narrowing in the carotid artery. An umbrella-shaped filter is placed beyond the narrowing to catch any dislodged plaque or debris. Once everything is in place, a balloon on the catheter is inflated, mashing the plaque into the artery wall and expanding a stent. The balloon is deflated; the catheter and filter are removed, leaving the stent in place to hold the artery open; and the incision in the groin is closed.

Downside of treatment

The main goal of carotid endarterectomy or angioplasty is to prevent a stroke from happening in the future. Both do this quite well. What makes deciding which procedure to have — or whether to have one at all — difficult is that both endarterectomy and angioplasty sometimes cause a stroke, the very problem they are trying to prevent, or, even worse, death.

Most people — upward of 90% — sail through CAS or carotid endarterectomy without a hitch. Nationally, about five people in 100 have a stroke or die as a result of a procedure to clear a clogged carotid artery. The rate is much lower when the procedure is performed by a doctor who has done it many times.

In the first report from the Carotid Revascularization versus Stenting Trial (CREST), carotid surgery and CAS were, on the surface, equally safe and effective. But when the investigators drilled down into the data, some important differences emerged. Stroke was more common after CAS (4.1%) than after surgery (2.3%), while heart attack was more common after surgery (2.3%) than after CAS (1.1%). However, most of the heart attacks were mild, while most of the strokes caused some disability and reduced quality of life. As seen in other trials, individuals over age 69 did better with surgery than with CAS. The results were presented in February 2010 at an American Stroke Association conference in San Antonio.

Interim results from the ongoing International Carotid Stenting Study (ICSS) seem to tell a different story. They showed a higher rate of stroke, heart attack, or death with CAS (8.5%) than with surgery (5.2%) within 120 days of the procedure (The Lancet, March 20, 2010).

Clearer picture for CAS

To clarify these results, we polled the chiefs of vascular and endovascular surgery at Harvard Medical School's three main teaching hospitals: Dr. Michael Belkin of Brigham and Women's Hospital, Dr. Richard A. Cambria of Massachusetts General Hospital, and Dr. Frank Pomposelli of Beth Israel Deaconess Medical Center.

All agreed that the differences between CAS and surgery are getting smaller due to the improvements in CAS since it was first introduced. In expert hands, they say that CAS can be a viable alternative to carotid endarterectomy. A big reason for the differences in results between the two trials is that doctors had to demonstrate considerably more expertise to participate in CREST than in ICSS. That means the ICSS findings likely reflect what will happen with CAS when done by doctors of varying skill.

Differences remain

When carotid angioplasty was first developed, doctors hoped it would be just as effective as carotid endarterectomy but easier on the body. That hasn't panned out. Both procedures take an hour or two to perform, and both require only a one-night stay in the hospital. Full recovery is a bit quicker from CAS than from endarterectomy, but this difference isn't nearly as big as it is between coronary angioplasty and bypass surgery.
On the safety side, carotid endarterectomy has set a high bar. As operations go, it is quite safe, with rates of stroke, heart attack, or death as low as 1% to 2% in centers where the operation is performed often (at least once a week) by experienced teams. CAS comes close to this when done in centers of excellence, as shown by the CREST results, but doesn't quite match it.

There is another difference between the two procedures with as-yet unknown consequences. During CAS, when the catheter is pushed through the narrowing in the carotid artery, platelets and bits of fatty plaque break free and get into the bloodstream. Umbrella-like devices are used to capture these particles (called emboli) before they get too far, but some escape and reach the brain. Surgery releases far fewer particles because the artery is clamped before the operation begins. Whether this shower of particles affects brain function is a matter of research and dispute.

Choosing a procedure

So, what to do if you have a narrowed carotid artery?

If it isn't too severe (less than 70% narrowed) or causing any symptoms, your best bet is medical therapy. If the narrowing is severe, or if it has already caused a transient ischemic attack or full-blown stroke, carotid artery surgery has a small edge over CAS for most people.

More important than which procedure you choose is the experience of the doctor who will perform it and how well his or her patients fare afterward. Don't be shy about asking for numbers: How many carotid artery procedures do you perform each year? What percentage of your patients have a stroke or die from the procedure? These are tough questions to ask, but they are the most important ones in your decision-making process

http://www.health.harvard.edu/newsletters/Harvard_Heart_Letter/2010/June/clearing-clogged-arteries-in-the-neck

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2010-05-26 08:14 浏览 : 3429 回复 : 18

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胭脂编辑于 2010-06-04 18:54

• 一图解读｜血常规化验单

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认领，24小时内未提交，其他战友可再次认领。

2010-06-01 16:16

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• 一图解读｜血常规化验单

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Clearing clogged arteries in the neck
Balloon angioplasty is getting better at unblocking carotid arteries, but surgery still has the edge.
Opening a blocked heart artery with a balloon and then propping it open with a wire-mesh stent has become a near-equal partner with bypass surgery for restoring blood flow to the heart. Although coronary angioplasty plus stenting isn't quite as durable as bypass surgery, it is much easier on the body, since it doesn't require opening the chest. Giving up a tiny bit of effectiveness for a much shorter recovery is an excellent trade-off for some people.
The situation is different in the carotid arteries, which convey oxygen-rich blood to the brain. In that territory, carotid angioplasty plus stenting (CAS) hasn't quite proved itself to be the equal of endarterectomy, an operation to clean out a clogged carotid artery. Results from one long-awaited clinical trial showed that CAS is nearly as safe and effective as carotid endarterectomy when done by an expert, while results from a second trial indicate that surgery is still the best bet for most people.
颈动脉内粥样斑块的清理
球囊扩张的血管成形术，在疏通颈动脉方面变得越来越好；但手术治疗颈动脉阻塞，仍然有一定的优势。
用球囊扩张术结合支架置入术，已经是治疗心脏动脉（冠状动脉）阻塞的常用方法。虽然冠状动脉腔内成形术合并支架置入术，并没有心脏搭桥手术那么耐用，但其操作容易，不需开胸手术。因而，对于患者来说，到底应该选用何种方法，还需根据患者自己情况进行综合的衡量。
这种阻塞的情况发生在颈动脉的话，又是一种什么情况呢？颈动脉能够将富含氧气的血液运送到大脑的不同位置，供给脑部的营养。若颈动脉内发生阻塞，以前曾有研究证明。通过支架成形术能够起到与外科手术切除动脉内膜起到的效果是一样的。而最近，又有一项新的研究表明，颈动脉内血管成形术有效，但颈动脉内膜切除术，仍然是大多数人的最佳选择。
An often-silent disease
The right and left carotid arteries branch off the aorta soon after it emerges from the heart and run up to the brain along either side of the neck. These vitally important arteries are prone to atherosclerosis, the damaging process that clogs arteries in the heart, kidneys, legs, and elsewhere.
A buildup of plaque in the carotids usually goes unnoticed. Sometimes it is discovered when a doctor hears "bruits" (BROO-ee) through a stethoscope in one or both carotid arteries. These soft, whooshing sounds are caused by turbulence as blood tumbles through a narrowing in a carotid artery. Clogged carotids are sometimes found during ultrasound exams of the neck and head. For most people, though, the first sign of trouble is a transient ischemic attack or a stroke.
Just as a heart attack is the big worry with cholesterol-clogged coronary arteries, brain attack (stroke) is the main hazard of plaque-narrowed carotid arteries. Plaque in a carotid artery can cause a stroke by restricting blood flow to part of the brain, or by breaking loose and completely blocking a smaller vessel in the brain.
无声的疾病
左，右颈总动脉是从总动脉分出后分别行走在脖子的两侧，将心脏的血液运输到脑部，供给脑部营养。这些极为重要的动脉容易发生动脉粥样硬化，除了在颈动脉、冠状动脉，还可发生在肾脏、腿部的动脉等其他地方。
颈动脉粥样斑块的集结，通常被忽视。有时医生听诊颈动脉时，在一侧或两侧听到杂音而发现。这些声音是由血液通过在颈内动脉狭窄地段，而引起的湍流声。有时在颈部和头部超声波检查时，发现颈动脉粥样硬化。对于大多数人来说，遇到麻烦的第一个迹象是短暂性脑缺血发作或中风。
正如心脏病发作是与胆固醇堵塞冠状动脉；颈动脉变窄的危险，是脑部血流减少而引起中风。颈动脉斑块的限制可能导致流向大脑的血液减少、阻断大脑中的小血管等，引起中风。
Clearing a carotid artery

Endarterectomy removes fatty plaque through an incision in the neck. Angioplasty plus stenting opens the narrowing from the inside with a balloon and leaves behind a stent to hold the artery open.
通过在颈部切口去除内膜上的脂肪斑块。血管成形术加支架置入术，是通过扩张颈动脉内的狭窄而发挥作用的。
Opening a clogged carotid
There are two main ways to open a narrowed carotid artery.
Endarterectomy involves physically removing plaque from inside the carotid artery. A surgeon makes an incision in the neck to expose the artery, clamps the artery, then opens it lengthwise in the region of the narrowing. After scraping the fatty plaque out of the artery, the surgeon enlarges the artery with a diamond-shaped patch, stitches the artery together, then closes the skin of the neck.
Carotid angioplasty begins with a small incision into the femoral artery in the groin. A thin tube called a catheter is gently pushed into the artery and maneuvered up through the aorta into the narrowing in the carotid artery. An umbrella-shaped filter is placed beyond the narrowing to catch any dislodged plaque or debris. Once everything is in place, a balloon on the catheter is inflated, mashing the plaque into the artery wall and expanding a stent. The balloon is deflated; the catheter and filter are removed, leaving the stent in place to hold the artery open; and the incision in the groin is closed.
打开阻塞的颈动脉
主要有两种方法打开狭窄的颈动脉。颈动脉内膜切除术：外科医生切开颈部组织暴露动脉，用动脉夹阻止血流，然后在颈动脉的纵向缩小地区打开颈动脉，去除颈动脉内膜上多余的脂肪斑块，然后修复动脉，关闭颈部皮肤。
颈动脉血管成形术：一开始在腹股沟小切口出，进入股动脉，一根细管称为导管轻轻推入动脉，最后到达颈动脉狭窄处。一旦一步到位，对导管气球充气，压缩斑块到动脉壁和支架扩张。该气球泄气;导管和过滤器都被删除，支架留在动脉狭窄处以扩张动脉，关闭腹股沟处切口。

Downside of treatment
The main goal of carotid endarterectomy or angioplasty is to prevent a stroke from happening in the future. Both do this quite well. What makes deciding which procedure to have — or whether to have one at all — difficult is that both endarterectomy and angioplasty sometimes cause a stroke, the very problem they are trying to prevent, or, even worse, death.
Most people — upward of 90% — sail through CAS or carotid endarterectomy without a hitch. Nationally, about five people in 100 have a stroke or die as a result of a procedure to clear a clogged carotid artery. The rate is much lower when the procedure is performed by a doctor who has done it many times.
In the first report from the Carotid Revascularization versus Stenting Trial (CREST), carotid surgery and CAS were, on the surface, equally safe and effective. But when the investigators drilled down into the data, some important differences emerged. Stroke was more common after CAS (4.1%) than after surgery (2.3%), while heart attack was more common after surgery (2.3%) than after CAS (1.1%). However, most of the heart attacks were mild, while most of the strokes caused some disability and reduced quality of life. As seen in other trials, individuals over age 69 did better with surgery than with CAS. The results were presented in February 2010 at an American Stroke Association conference in San Antonio.
Interim results from the ongoing International Carotid Stenting Study (ICSS) seem to tell a different story. They showed a higher rate of stroke, heart attack, or death with CAS (8.5%) than with surgery (5.2%) within 120 days of the procedure (The Lancet, March 20, 2010).
治疗的副作用
颈动脉内膜切除术或在血管成形术的主要目的在于防止在未来发生中风；而且这两种方法也确实有效。到底选用哪种方法更好，是一个非常困难的选择；而且有时这两种方法也都会引起中风、或更糟糕的问题如死亡。
在早期的研究中，其中研究对象中的大多数人（高达90％）接受了颈动脉内膜切除术或血管成形术。，最后去中风的几率也相对较低，但也主要与此次。在全国范围内，大约有5 %患有中风或死于手术过程中。当医生的技术非常熟练时，这个比率也会降低。
这两种方法从表面上看，是同样安全、有效的。但经过详细的调查研究后会发现有些明显的不同。对于颈动脉内膜切除术来说，其中风的比率一般是2.3%；而血管成形术，其术后中风的比率则是4.1%。而颈动脉内膜切除术，其术后心脏病发作的比率术2.3%；而血管成形术，其术后中风的比率则是1.1%。大部分心脏病发作都是轻微的；而中风的发作，则会致残、降低生活质量。
而另外的一项研究则表明：对于年龄超过69岁的患者来说，其选择颈动脉内膜切除术的效果要好于血管成形术；这项研究结果，在2010年2月的美国圣安东尼奥举行的中风协会会议上公布。
而此项研究结果，于2010年3月20日发表在《柳叶刀》杂志上的另外一项研究的结果完全不同。其公布的是血管成形术导致术后120天内中风、心脏病发作、或死亡的几率(8.5%)高于颈动脉内膜切除术的(5.2%)
Clearer picture for CAS
To clarify these results, we polled the chiefs of vascular and endovascular surgery at Harvard Medical School's three main teaching hospitals: Dr. Michael Belkin of Brigham and Women's Hospital, Dr. Richard A. Cambria of Massachusetts General Hospital, and Dr. Frank Pomposelli of Beth Israel Deaconess Medical Center.
All agreed that the differences between CAS and surgery are getting smaller due to the improvements in CAS since it was first introduced. In expert hands, they say that CAS can be a viable alternative to carotid endarterectomy. A big reason for the differences in results between the two trials is that doctors had to demonstrate considerably more expertise to participate in CREST than in ICSS. That means the ICSS findings likely reflect what will happen with CAS when done by doctors of varying skill.
更清楚地了血管成形术
为了澄清这些结果，我们调查的哈佛医学院的教学医院的三个主要血管和血管内手术的首领：布里格姆妇女医院的迈克尔贝尔金博士，坎布里亚马萨诸塞州总医院的理查德A医生，贝丝以色列女执事医疗中心的弗兰克蓬波塞利医生。
大家一致认为，血管成形术和手术之间的差异越来越小，由于血管成形术在不断的改善。

Differences remain
When carotid angioplasty was first developed, doctors hoped it would be just as effective as carotid endarterectomy but easier on the body. That hasn't panned out. Both procedures take an hour or two to perform, and both require only a one-night stay in the hospital. Full recovery is a bit quicker from CAS than from endarterectomy, but this difference isn't nearly as big as it is between coronary angioplasty and bypass surgery.
On the safety side, carotid endarterectomy has set a high bar. As operations go, it is quite safe, with rates of stroke, heart attack, or death as low as 1% to 2% in centers where the operation is performed often (at least once a week) by experienced teams. CAS comes close to this when done in centers of excellence, as shown by the CREST results, but doesn't quite match it.
There is another difference between the two procedures with as-yet unknown consequences. During CAS, when the catheter is pushed through the narrowing in the carotid artery, platelets and bits of fatty plaque break free and get into the bloodstream. Umbrella-like devices are used to capture these particles (called emboli) before they get too far, but some escape and reach the brain. Surgery releases far fewer particles because the artery is clamped before the operation begins. Whether this shower of particles affects brain function is a matter of research and dispute.
分歧依然
最初的颈动脉血管成形术，医生其将与颈动脉内膜切除术一样，但对人体更容易有效。这并没有兑现。这两个程序都需要一两个小时，都需要在医院里住宿一晚。血管成形术恢复的有点快，比颈动脉内膜切除术，但这种差异并不大，因为它几乎和冠状动脉腔内成形术与旁路手术的关系一样。
在安全方面，颈动脉内膜切除术已成立一个高标准。其术后的中风、心脏病发作、死亡的风险相对低；而血管成形术则相对较高。
还有一个很大的差异。血管成形术，当导管通过颈内动脉狭窄的作用下，血小板和脂肪斑块破裂自由进入血液。外科手术的话。释放的粒子少得多，因为动脉是手术前开始夹紧。这是否会影响脑部的血流问题呢。
Choosing a procedure
So, what to do if you have a narrowed carotid artery?
If it isn't too severe (less than 70% narrowed) or causing any symptoms, your best bet is medical therapy. If the narrowing is severe, or if it has already caused a transient ischemic attack or full-blown stroke, carotid artery surgery has a small edge over CAS for most people.
More important than which procedure you choose is the experience of the doctor who will perform it and how well his or her patients fare afterward. Don't be shy about asking for numbers: How many carotid artery procedures do you perform each year? What percentage of your patients have a stroke or die from the procedure? These are tough questions to ask, but they are the most important ones in your decision-making process.
选择一个方法
如果您有颈动脉狭窄，您应该怎么做呢？如果狭窄不是太严重（低于70％）的话，或没有造成任何症状的话，最好的办法是药物治疗。如果是严重的狭窄，或者它已引起短暂性脑缺血发作或全面爆发的中风，颈动脉手术已经比大多数人血管成形术更有优势。更重要的不是你选择何种程序？更重要的医生将如何执行好它。

版主胭脂留言:
不错的翻译，如果能适当分段/加粗小标题，就更好了

2010-06-01 20:26

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胭脂编辑于 2010-06-01 22:04

• 一天吃200片复方甘草片连续吃两年，停药后戒断症状有咳嗽这个表现吗？

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总共2078字，希望多加分。

颈动脉内粥样斑块的清理

球囊扩张的血管成形术，在疏通颈动脉方面变得越来越好；但手术治疗颈动脉阻塞，仍然有一定的优势。

用球囊扩张术结合支架置入术，已经是治疗心脏动脉（冠状动脉）阻塞的常用方法。虽然冠状动脉腔内成形术合并支架置入术，并没有心脏搭桥手术那么耐用，但其操作容易，不需开胸手术。因而，对于患者来说，到底应该选用何种方法，还需根据患者自己情况进行综合的衡量。

这种阻塞的情况发生在颈动脉的话，又是一种什么情况呢？颈动脉能够将富含氧气的血液运送到大脑的不同位置，供给脑部的营养。若颈动脉内发生阻塞，以前曾有研究证明。通过支架成形术能够起到与外科手术切除动脉内膜起到的效果是一样的。而最近，又有一项新的研究表明，颈动脉内血管成形术有效，但颈动脉内膜切除术，仍然是大多数人的最佳选择。

无声的疾病
左，右颈总动脉是从总动脉分出后分别行走在脖子的两侧，将心脏的血液运输到脑部，供给脑部营养。这些极为重要的动脉容易发生动脉粥样硬化，除了在颈动脉、冠状动脉，还可发生在肾脏、腿部的动脉等其他地方。

颈动脉粥样斑块的集结，通常被忽视。有时医生听诊颈动脉时，在一侧或两侧听到杂音而发现。这些声音是由血液通过在颈内动脉狭窄地段，而引起的湍流声。有时在颈部和头部超声波检查时，发现颈动脉粥样硬化。对于大多数人来说，遇到麻烦的第一个迹象是短暂性脑缺血发作或中风。

正如心脏病发作是与胆固醇堵塞冠状动脉；颈动脉变窄的危险，是脑部血流减少而引起中风。颈动脉斑块的限制可能导致流向大脑的血液减少、阻断大脑中的小血管等，引起中风。

清理颈动脉

血流（blood flow）；狭窄、痉挛（spasm）；冠状动脉（coronary artery）
通过在颈部切口去除内膜上的脂肪斑块。血管成形术加支架置入术，是通过扩张颈动脉内的狭窄而发挥作用的。

打开阻塞的颈动脉

主要有两种方法打开狭窄的颈动脉。颈动脉内膜切除术：外科医生切开颈部组织暴露动脉，用动脉夹阻止血流，然后在颈动脉的纵向缩小地区打开颈动脉，去除颈动脉内膜上多余的脂肪斑块，然后修复动脉，关闭颈部皮肤。
颈动脉血管成形术：一开始在腹股沟小切口出，进入股动脉，一根细管称为导管轻轻推入动脉，最后到达颈动脉狭窄处。一旦一步到位，对导管气球充气，压缩斑块到动脉壁和支架扩张。该气球泄气;导管和过滤器都被删除，支架留在动脉狭窄处以扩张动脉，关闭腹股沟处切口。

治疗的副作用

颈动脉内膜切除术或在血管成形术的主要目的在于防止在未来发生中风；而且这两种方法也确实有效。到底选用哪种方法更好，是一个非常困难的选择；而且有时这两种方法也都会引起中风、或更糟糕的问题如死亡。

在早期的研究中，其中研究对象中的大多数人（高达90％）接受了颈动脉内膜切除术或血管成形术。，最后去中风的几率也相对较低，但也主要与此次。在全国范围内，大约有5 %患有中风或死于手术过程中。当医生的技术非常熟练时，这个比率也会降低。

这两种方法从表面上看，是同样安全、有效的。但经过详细的调查研究后会发现有些明显的不同。对于颈动脉内膜切除术来说，其中风的比率一般是2.3%；而血管成形术，其术后中风的比率则是4.1%。而颈动脉内膜切除术，其术后心脏病发作的比率术2.3%；而血管成形术，其术后中风的比率则是1.1%。大部分心脏病发作都是轻微的；而中风的发作，则会致残、降低生活质量。

而另外的一项研究则表明：对于年龄超过69岁的患者来说，其选择颈动脉内膜切除术的效果要好于血管成形术；这项研究结果，在2010年2月的美国圣安东尼奥举行的中风协会会议上公布。

而此项研究结果，于2010年3月20日发表在《柳叶刀》杂志上的另外一项研究的结果完全不同。其公布的是血管成形术导致术后120天内中风、心脏病发作、或死亡的几率(8.5%)高于颈动脉内膜切除术的(5.2%)。

更清楚地了解血管成形术

为了澄清这些结果，我们调查的哈佛医学院的教学医院的三个主要血管和血管内手术的首领：布里格姆妇女医院的迈克尔贝尔金博士，坎布里亚马萨诸塞州总医院的理查德A医生，贝丝以色列女执事医疗中心的弗兰克蓬波塞利医生。

大家一致认为，血管成形术和手术之间的差异越来越小，由于血管成形术在不断的改善。

分歧依然

最初的颈动脉血管成形术，医生其将与颈动脉内膜切除术一样，但对人体更容易有效。这并没有兑现。这两个程序都需要一两个小时，都需要在医院里住宿一晚。血管成形术恢复的有点快，比颈动脉内膜切除术，但这种差异并不大，因为它几乎和冠状动脉腔内成形术与旁路手术的关系一样。

在安全方面，颈动脉内膜切除术已成立一个高标准。其术后的中风、心脏病发作、死亡的风险相对低；而血管成形术则相对较高。

还有一个很大的差异。血管成形术，当导管通过颈内动脉狭窄的作用下，血小板和脂肪斑块破裂自由进入血液。外科手术的话。释放的粒子少得多，因为动脉是手术前开始夹紧。这是否会影响脑部的血流问题呢。

选择一个方法

如果您有颈动脉狭窄，您应该怎么做呢？如果狭窄不是太严重（低于70％）的话，或没有造成任何症状的话，最好的办法是药物治疗。如果是严重的狭窄，或者它已引起短暂性脑缺血发作或全面爆发的中风，颈动脉手术已经比大多数人血管成形术更有优势。更重要的不是你选择何种程序？更重要的医生将如何执行好它。

2010-06-01 20:28

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胭脂编辑于 2010-06-04 18:57

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