Surgery for carotid artery stenosis
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《英国医生杂志》
EDITOR—I am pleased that my editorial has evoked responses about the looming epidemic of stroke, often the result of carotid artery disease. We hope that all risk factors will be reduced by careful attention to good health habits including diet, smoking, blood pressure control, etc, and in selected cases, platelet anti-aggregants and statins.1 For patients who, despite control of risk factors, go on to develop severe, carotid bifurcation atherosclerosis, simple methods now exist to identify preclinical disease by using ultrasound and for delineation of transient ischaemic attack with a short questionnaire.2 Auscultation for bruits is practical depending on the auscultatory technique and ambient noise. Identifying cases is of little benefit unless the opportunity to intervene exists in the healthcare system.
It would be foolhardy to make blanket or case specific recommendations for medical and surgical management. Moreover, screening has nothing to do with the treatment that might be provided, which should most often be reduction of risk factors. It must never be considered that the reason for screening is to identify people who might be subjected to an interventional procedure such as stent, balloon angioplasty, or endarterectomy. It is for this reason that I urge that non-procedure oriented physicians be firmly in charge of the screening and the recommendations that are made.
I am among those who suspect that the condition of the carotid artery is a marker for atherosclerosis in other organs, particularly the heart. If the easily accessible carotid artery could be used as the indicator for the other arteries, including the coronaries, abdominals, and cerebral circulation, this would be a big step forward. It may be premature to call for mass screening, but it is highly appropriate for individual doctors to use the technology now at hand for identification of cases and early intervention with long term follow up designed to reduce risk.
James F Toole, director
Stroke Research Center, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1068, USA jtoole@wfubmc.edu
Competing interests: None declared.
References
Toole JF, Sane D, Bettermann K. Stroke prevention: optimizing the response to a common threat. JAMA 2004;292: 1885-7.
Karanjia PN, Nelson JJ, Lefkowitz DS, Dick AR, Toole JF, Chambless LE, et al. Validation of the ACAS TIA/stroke algorithm. Neurology 1997;48: 346-51.
It would be foolhardy to make blanket or case specific recommendations for medical and surgical management. Moreover, screening has nothing to do with the treatment that might be provided, which should most often be reduction of risk factors. It must never be considered that the reason for screening is to identify people who might be subjected to an interventional procedure such as stent, balloon angioplasty, or endarterectomy. It is for this reason that I urge that non-procedure oriented physicians be firmly in charge of the screening and the recommendations that are made.
I am among those who suspect that the condition of the carotid artery is a marker for atherosclerosis in other organs, particularly the heart. If the easily accessible carotid artery could be used as the indicator for the other arteries, including the coronaries, abdominals, and cerebral circulation, this would be a big step forward. It may be premature to call for mass screening, but it is highly appropriate for individual doctors to use the technology now at hand for identification of cases and early intervention with long term follow up designed to reduce risk.
James F Toole, director
Stroke Research Center, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1068, USA jtoole@wfubmc.edu
Competing interests: None declared.
References
Toole JF, Sane D, Bettermann K. Stroke prevention: optimizing the response to a common threat. JAMA 2004;292: 1885-7.
Karanjia PN, Nelson JJ, Lefkowitz DS, Dick AR, Toole JF, Chambless LE, et al. Validation of the ACAS TIA/stroke algorithm. Neurology 1997;48: 346-51.