頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用課件

1、頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用Division of Vascular SurgeryDepartment of Cardiovascular MedicineIntermountain Health Care, Salt Lake City, Utah頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用 1996-2000, 8258 strokes, 10 populations 75% CT scans Hemorrhagic29.3%Ischemic62.4% Embolic?Intracranial? 20 %頸動脈內(nèi)膜剝

2、脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用 Carotid Endarterectomy (CEA) in USA 200,000 cases/yearCEA in China : 200 cases/year頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用 No formal training Poor outcomes (in the past) Patients present with advanced disease CEA devel

3、oped concurrent with CAS Financial incentives for CAS over CEA Limited Referrals from medical doctors Patient fear of surgery頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用 頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用MedicalSurgicalRelative Risk Reduction30 day stroke3.3 %5.8%Cumulative stroke26%9% 65%Fatal stroke13.1

4、%2.5% 81%2 yr stroke no 30 d stroke12.2%1.6%頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用SurgeryMedical30 day stroke/mortality2.3%5 year ipsilateral stroke5.1%11%頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用 CEA becomes the “gold standard” for treatment of extra-cranial carotid stenosis. Guidelines for CEA are established. Rate of CEA increases. (200,000 CEA/yr)頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用頸動脈內(nèi)膜剝脫術(shù)對預(yù)防中風(fēng)所起的作用30 day mortality 2 %Stroke RateAsymptomatic 3%TIA 5%Prior infarct 7%Recurrent Stenosis0.99MI6.6%4.4%p CAS CEA