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How to identify which patients with asymptomatic carotid stenosis could benefit from endarterectomy or stenting Kosmas I Paraskevas, Frank J Veith, J David Spence doi: 10.1136/svn-2017-000129 Citation: Paraskevas KI, Veith FJ, Spence JD. How to identify which patients with asymptomatic carotid stenosis could benefit from endarterectomy or stenting. Stroke and Vascular Neurology 2018; svn-2017-000129. doi: 10.1136/svn-2017-000129 Stroke & Vascular Neurology（SVN）新近上线文章“How to identify which patients with asymptomatic carotid stenosis could benefit from endarterectomy or stenting”，由来自英国伦敦皇家自由医院（Royal Free Hospital）血管与腔内血管外科Kosmas I Paraskevas执笔、美国纽约大学朗格尼医学中心（New York University Langone Medical Center）血管外科/美国俄亥俄州克利夫兰诊所（Cleveland Clinic）血管外科Frank J Veith，以及加拿大安大略省伦敦市西安大略大学Robarts研究所卒中预防与动脉粥样硬化研究中心J David Spence教授共同参与完成。 常规颈动脉内膜剥脱术（carotid endarterectomy, CEA）或颈动脉支架置入术（carotid artery stenting, CAS）已不再作为无症状性颈动脉狭窄（asymptomatic carotid artery stenosis, ACS）患者的最佳治疗方案。在过去的几年里，开展了许多研究，旨在明确未来脑血管病事件的可靠预测因子，从而识别ACS高危患者，并为这些患者提供预防性颈动脉干预治疗，以防止进展为症状性颈动脉狭窄（symptomatic carotid stenosis, SCS）。所有ACS患者均应接受最佳药物治疗（best medical treatment, BMT）。本文总结了识别这些高危无症状性颈动脉狭窄个体的方法：1）经颅多普勒（transcranial Doppler, TCD）微栓子检测；2）彩色血流双功能超声检测颈动脉斑块回声；3）ACS严重程度进展；4）头颅CT/MRI显示静态栓塞性脑梗死；5）脑血管储备功能降低；6）低-无回声区域（juxtaluminal black hypoechoic area, JBA）增加；7）MRI显示斑块内出血；8）颈动脉斑块表面溃疡，并进一步深入分析了ACS患者从干预治疗中获益的比例，敬请关注！ Figure 1. Transcranial Doppler embolus detection Figure 2. Carotid ulcer volume as a predictor of risk Figure 3. Event-free survival in asymptomatic carotid stenosis with and without microemboli on transcranial Doppler since 2003 Figure 4. Imaging of active calcification by PET/CT with F Sodium Fluoride
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