按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,200,8,*,GDPPH,JF Luo,Intervention for Asymptomatic Carotid Stenosis should be Stratified,罗建方 广东省人民医院,Jianfang Luo,M.D.,Guangdong Cardiovascular Institute,Guangdong Provincial Peoples Hospital,2021,The mechanism of stroke with carotid lesion,Emboli,Hypoperfusion,Clinical symptoms caused by embolic disease in 80%of patients,75%,risk of stroke in 1,st,yr=,2-5%,Roederer et al.Stroke,1984,Hennereci et al.Brain,1987,2021,Major stroke by stenosis severity,2021,Risk of stroke in patients with asymptomatic carotid stenosis has fallen significantly.,Abbott et al.,International Journal of Stroke,2007,.,2021,ATROCAP,：,Atorvastatin 20mg Stabilize plaque,“Stabilizing plaque is an important mechanism to reduce cardiovascular and cerebral events.,Mean Percent change%),-60,-50,-40,-30,-20,-10,0,Ulceration,Inflammation,Macrophage,Placebon=30,Lipitor20mgn=29,Cortellaro M et al.Thromb Haemost.2002;88:41-47.,2021,Risk Stratification of Asymptomatic Carotid Stenosis,Eur J Vasc Endovasc Surg xx,1e10(2021),2021,Plaque morphology：“High Risk,2021,“Vulnerable plaque in carotid specimen,2021,Lesion morphologies in carotid artery,2021,Plaque Morphology and Stroke Risk,Ulceration=Iminent stroke,risk of stroke =,7,.,5%,Autret et al.Lancet,1987,Heterogeneous and ulcerated lesions =Risk,2-4 x,Langsfeld,et al.,J Vasc Surg,1989,Sterpetti,et al.,Stroke,1988,2021,What we know now,The risk of stroke is relevant to severity of stenosis,Histological data from the coronary and carotid circulations suggest that,other plaque features,may be more important in predicting future thrombo-embolic events.,2021,Revascularization,for Asymptomatic Carotid Stenosis,Stratification Strategy,2021,颈动脉狭窄的治疗方法,1药物治疗,Medical Therapy,2颈动脉内膜剥离术,Carotid Endarterectomy,CEA,3经皮颈动脉支架植入术,Carotid Artery Stenting,CAS,2021,The Cochrane Collaboration 2006,ASA 2006,2021,Step 1,：,High Risk of Stroke,Severe Carotid Stenosis 80%,+,Unfavorable Plaque Features,ulceration or heterogenecity,2021,Step 2,：,High Risk for Stenting,High risk Patients,80 y of age (asymptomatic),Access problems,Baseline large neurological defect,Marked cerebral atrophy+microangiopathy,Dementia/Alzheimer,High risk Anatomy,Obvious filling defect/thrombus,Vessel occlusion,“String sign -asymptomatic,Severe distal loops/kinks/bends,Heavy concentric calcifications,Type III aorta arch,2021,High risk for intervention,2021,Any 2 of the following=High Risk,AGE 80,Cerebral Reserve,Excessive Tortuosity,Heavy concentric,calcification,Criteria of High Risk Carotid Stenting,2021,Proposed New Paradigm,Carotid Revascularization Indicated?,Yes,No,High Stent Risk,Yes,No,Medical Management,Surveillance,CEA if low risk,Carotid Stent,Need good training,Dont forget optimal medical therapy!,2021,Thank you!,2021,