Contemporary management of carotid bifurcation atherosclerosis for stroke prevention: management options and patient selection.

摘要

There are few areas in vascular surgery more extensively studied than the role of carotid bifurcation stenosis in stroke treatment. In 1951, C. M. Fisher identified the relationship of carotid bifurcation atheroma and stroke. Within a year or two, surgeons in 3 continents successfully treated carotid bifurcation lesions in patients with ongoing cerebrovascular insufficiency.Their initial hope that removal or bypass of these lesions would reverse the clinical stroke syndrome proved unfounded in the majority of cases. Within a decade of the first successful carotid reconstructions, the Joint Study on Extracranial Arterial Occlu-sive Disease was undertaken. This study, which involved surgeons, internists, and neurologists, prospectively randomized 5000 patients with lesions of the extracranial carotid and vertebral arteries. The lessons learned served as the basis to define the role of surgery of the carotid and vertebral arteries for stroke prevention. The model of critical prospective multidisciplinary analysis has been applied over subsequent decades to evaluate carotid endarterec-totny in Europe and North America for both symptomatic and asymptomatic patients and is currently being used to evaluate a new technology-carotid angioplasty and stenting.