無症狀性頸動脈狹窄治療：病例報告

內頸動脈狹窄是導致缺血性中風的重要原因之一，動脈粥狀硬化是導致頸動脈狹窄的主要因素。頸動脈狹窄可分為症狀性及無症狀性，臨床處置方法不同。針對無症狀性頸動脈狹窄的患者，採用內科治療控制高血壓、高血脂及糖尿病等慢性疾病是首要步驟；高風險族群則可進一步評估接受介入性治療，包括頸動脈內膜切開術（carotid endarterectomy, CEA）及頸動脈血管成形術併支架置放（carotid angioplasty with stent, CAS）。本文報告一位54歲中年男性，患有高血壓、高血脂、糖尿病，因右側頸脈動脈100%阻塞導致左側偏癱住院。頸動脈超音波另發現左側頸動脈中度阻塞（50-60% stenosis）。除給予抗血小板藥物及慢性病藥控制外，在中風半年症狀穩定後也進行預防性左側頸動脈支架置放。針對無症狀性頸動脈狹窄治療是否該進行介入性治療預防中風發生仍存有爭議，本文希望以此個案為例，討論無症狀性頸動脈狹窄治療最新建議及指引。

關鍵字

無症狀性頸動脈狹窄；頸動脈內膜切開術；頸動脈支架

並列摘要

Managing internal carotid artery (ICA) stenosis is an important element in stroke prevention. ICA stenosis, which can be divided into symptomatic and asymptomatic ones, warrants different treatments. For patients with asymptomatic ICA stenosis, medical therapies for controlling chronic diseases, such as hypertension, diabetes mellitus and hyperlipidemia, are top priorities for preventing stroke. For those at a higher risk of developing stroke, interventional procedures like carotid revascularization, including carotid endarterectomy (CEA) or carotid artery stent (CAS), should be considered. The paper reports a case of a 54-year-old male admitted for total occlusion of the right ICA with left hemiplegia. Carotid duplex revealed moderate (50~60%) left ICA stenosis. The patient received left carotid artery stent for stroke prevention 6 months later under stable condition. Whether interventional procedures should be applied to prevent stroke in patients with asymptomatic ICA stenosis has remained a controversial issue. The case study presents an example that helps update the information and offers suggestions and insights about the management of asymptomatic carotid artery stenosis.

並列關鍵字

asymptomatic carotid stenosis ； carotid endarterectomy ； carotid artery stent

國際替代計量

無症狀性頸動脈狹窄治療：病例報告

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