预防卒中：支架vs手术

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Preventing Strokes: Stents vs. Surgery
预防卒中：支架vs手术
Study Shows Stents Are Effective in High-Risk Patients
研究指出，支架治疗对高风险患者有效
April 9, 2008 -- A less invasive alternative to surgery for clearing neck arteries of plaque proved as effective as surgical treatment for preventing strokes in high-risk patients in a three-year follow-up study.
2008年4月9日---通过3年对易患卒中的高危人群随访研究发现，通过一种微创的外科治疗方法来清除颈动脉斑块可以获得与外科手术同样的预防效果。
Carotid artery stenting was compared to open-neck surgery in 260 patients considered less than optimal surgical candidates at high risk for strokes.
通过对没有最佳手术时机的260名卒中高风险患者的治疗，比较了颈动脉支架术与开放式颈部手术的疗效。
Stenting is routinely used to open plaque-clogged coronary arteries, which cause heart attacks. But it is still largely considered an experimental treatment for opening the clogged neck arteries that lead to strokes.
支架术通常用于开通可以引起心脏病发作的受阻冠状动脉。但是人们也实验性的用它来治疗可以引起卒中的颈动脉阻塞。
The newly published findings are the first to show long-term outcomes for neck stenting to be comparable to surgery in high-risk patients, University of Michigan interventional cardiologist Hitinder S. Gurm, MD, tells WebMD.
最新的研究首次报道了了对卒中高危患者实施颈动脉支架术和外科手术长期长期随访结果。密歇根大学介入心血管专家Hitinder S. Gurm在WebMD访谈中如是说。
The study appears in the April 10 issue of the New England Journal of Medicine. The research was funded by Johnson & Johnson's Cordis, which makes the stent used in the study.
新英格兰Journal of Medicine刊载了这项研究结果。这项研究由Johnson & Johnson's Cordis资助，该赞助者是研究中所用支架的制造商。
\"This is the first data we have to suggest that these two procedures have similar long-term benefits,\" Gurm says. \"But the findings only apply to high-risk patients. The trials examining lower-risk populations are going on now, and we hope to know more over the next few years.\"
“这是我们的初次数据，它表明了这两种治疗方法对卒中有着相同的长期预防率”Gurm说“但是结果仅适用于高危人群，对低危人群的实验现在正在进行中，我们希望在未来几年了解更多这方面的信息”
Stent vs. Surgery
支架术vs外科手术
The patients who took part in the study were treated at 29 hospitals around the U.S. All were considered at increased risk for complications with surgery because of advanced age (over 80), co-morbid conditions (heart failure, advanced coronary artery disease, lung disease) or a history of prior neck surgery or radiation. Most also had symptoms associated with carotid artery narrowing.
参加该研究的患者在全美国29所医院接受治疗。所有患者均被认为有较高的手术并发症发生率因为考虑其年龄（大于80岁），合并疾病（心衰，进行性冠心病，肺部疾病）或者先前颈部有手术史和受放疗史。大多数人也有颈动脉狭窄的症状。
Roughly half were treated with surgery, known as carotid endarterectomy, which involves opening the blocked carotid artery surgically to manually clear out accumulated plaque.
其中大概一半患者接受了如颈动脉内膜剥离术的手术治疗，这种治疗方法是切开阻塞的颈动脉直接手动清除动脉粥样斑块。
The other half got stents -- tiny wire mesh tubes threaded into the neck artery from an incision in the arm or groin. A filter designed to capture plaque and other debris freed from the arterial walls during the procedure was also used during stent implantation.
另一半患者则接受支架术—细线样网状导管从手臂或者腹股沟的切开口进入动脉到达颈动脉。一种滤光镜设计用来寻找斑块和其他从动脉壁上游离的碎片，同时它也在安放支架时候使用。
Of the participants available for follow-up, 41 of 143 stent-treated patients and 45 of the 117 patients treated with surgery had suffered a heart attack, a stroke, or had died within three years.
在可以随访的受试者中，3年内，143名接受支架治疗患者中的41名患者和117名接受外科手术治疗的45名患者心脏病发作，发生卒中或者死亡。
Most of the deaths were from cardiac or other non-stroke-related causes.
大多数死亡患者死于心脏病或者其他非卒中疾病。
Strokes accounted for about a third of the adverse events recorded, but most were not serious enough to be life-threatening.
1/3的不良事件由卒中引起，但是大多数并未严重到危及生命。
Follow-up Needed
随访的需要
The findings suggest that outcomes with surgery and stenting are similar among high-risk patients, but that doesn't mean that stenting will always be the best choice for this group, Gurm says. Importantly, this trial did not include a set of patients treated with medications alone.
结果表明在高风险患者中手术治疗和支架治疗的结果类似，但是这并不意味着对这部分人群支架治疗是最好的原则，Gurm说。重要的是，该研究并没有设立单独接受药物治疗的干预组。
\"The first thing a patient who has a high surgical risk should discuss with their doctor is whether they really need either procedure,\" he tells WebMD.
“有高手术风险患者及其主管医生考虑的首要问题是，他是否确实需要支架术或者手术治疗”，Gurm说。
If the answer is yes, the next consideration should be the doctor's prior experience with surgery or stenting.
如果答案是需要的话，下一步考虑则是医生对手术和支架治疗的掌握程度问题。
\"There are those that do both, but most people working in this field are either good at surgery or good at stenting,\" he says.
“有医生两种方法都能掌握，但是大多数人在这一领域要不擅长手术治疗，要不擅长支架治疗”
UCLA Medical Center vascular surgeon Wesley S. Moore, MD, tells WebMD that three years of follow-up is not enough to prove that stenting and surgery are equal for the treatment of high-risk patients with carotid artery blockage.
UCLA医疗中心血管外科的Wesley S. Moore对WebMD说3年的随访研究并不能证明支架术和外科手术对颈动脉阻塞的卒中高危人群患者有着同等的疗效。
He adds that there is some evidence that neck arteries cleared using stents become clogged again more quickly than those cleared by surgical means.
他补充到有一些证据显示通过支架术清除颈动脉斑块，比接受外科手术清除斑块的患者更容易复发。
\"This may not show up in three years, but we can't really say if this is the case at four and even five years,\" he says.
他说“这种复发率的增高可能不会在3年内表现出来，但是我们不能肯定4年甚至5年的随访结果也是这样。”
原文链接：
{http://content.nejm.org/cgi/content/abstract/358/15/1572}