- 期刊
頸動脈狹窄的處置指引
Guidelines for the Management of Carotid Artery Stenosis: A Statement from Taiwan Stroke Society Guideline Committee of Carotid Artery Stenosis Management
摘要
頸動脈狹窄易導致梗塞性腦中風發生，頸動脈內膜切除術(carotid endarterectomy, CEA)有助於預防梗塞性腦中風，近年頸動脈成型術併支架置放(carotid artery angioplasty, with or without stenting, CAS)漸爲多數病患選擇使用，但對於頸動脈狹窄的治療尚缺乏共識，台灣腦中風學會頸動脈狹窄處置共識小組整理與修訂第二版的頸動脈狹窄處置共識。具多重心血管危險因子、有症狀的冠狀動脈或周邊動脈疾病、接受頭頸部放射治療以及接受CEA或CAS後的病患追蹤可考慮頭動脈超音波篩檢，一般無血管疾病民眾則不建議篩檢。近一步評估頸動脈狹窄程度以傳統血管攝影爲優先考慮，也可考慮磁振照影或電腦斷層血管攝影。對於症狀性頸動脈狹窄爲70-99%，若術中腦中風與死亡併發症小於6%，可考慮以CEA治療，但不建議CEA用於治療頸動脈狹窄小於50%與術中可能發生高併發症者，接受CEA治療前、中與後均須持續使用抗血栓藥物，且應注重危險因子的控制與接受較佳的內科藥物治療。對於無法接受CEA治療、CEA治療後頸動脈再狹窄、經放射治療造成之頸動脈狹窄、合併有顱內遠端狹窄等可考慮以CAS治療。對於無症狀頸動脈狹窄以CEA治療，術中併發症必須低於3%才有助益。現階段CAS治療無症狀頸動脈狹窄主要爲CEA治療的高危險群，尚不建議於一般性的使用。
並列摘要
The severity of carotid artery stenosis can highly predict the occurrence of ischemic stroke. Carotid endarterectomy (CEA) has been shown to have greater benefit over medical therapy to prevent the strokes from symptomatic and asymptomatic carotid artery stenosis. Recently, carotid artery angioplasty with or without stenting (CAS) has emerged as an alternative therapy for carotid artery stenosis. The Taiwan Stroke Society revised the guidelines for management of carotid artery stenosis. Screening of carotid arteries by ultrasonography is suggested in subjects with multiple vascular risk factors, the presence of coronary artery or peripheral vascular diseases, post-radiotherapy of head and neck, and post-CEA or CAS. General population screening is not suggested. Cerebral angiography is still the standard for determination of carotid artery stenostic severity. CEA can be performed in symptomatic patients with carotid artery stenosis 70-99% and perioperative stroke and mortality rates less than 6%. CEA should not be done in patients with carotid artery stenosis greater than 50% and high surgical risks. Continuous antithrombotic agents and risk factor control post-intervention are needed. CAS can be considered if patients are unable to receive CEA, post-radiotherapy, and the presence of tandem stenosis. CEA may be performed in asymptomatic patients if the perioperative complication is less than 3%. CAS is not suggested for routine use in asymptomatic patients unless high surgical risks for CEA.
延伸閱讀
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- 張豐基（2010）。神經介入微創治療 頸動脈狹窄。健康世界，(290)，44-46。https://doi.org/10.6454/HW.201002.0044
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