【交流】无症状的颈动脉狭窄的处理（NEJM）
这个帖子发布于 17 年零 68 天前，其中的信息可能已发生改变或有所发展。
NEJM四月份一个病例讨论题，现在结果已经出来了，看来对于无症状的颈动脉狭窄患者的处理仍然是个充满争议的话题。
Case Vignette（病例讨论）
A 67-year-old man with a history of hypertension and hyperlipidemia is seen for a
routine examination. His medications include hydrochlorothiazide (25 mg daily),
simvastatin (20 mg daily), and aspirin (81 mg daily). He drinks alcohol rarely and
does not smoke. 患者，67岁男性，偶有饮酒，不吸烟。既往有高血压和和高脂血症，目前口服氢氯噻嗪（25 mg、qd）、辛伐他丁（20mg、qd）和阿司匹林（81mg、qd）。体格检查：体重指数27，超重，血压140/85 mm Hg，心率72bpm，律齐。心脏检查正常，听诊右侧颈部下颌角处可闻及中度收缩性杂音，神经系统检查正常。
His body-mass index (the weight in kilograms divided by the square of the height in meters) is 27, consistent with overweight. His blood pressure is 140/85 mm Hg, and his heart rate is 72 beats per minute and regular. His cardiac examination is normal.
Auscultation of the neck shows normal carotid upstrokes but reveals a middle-pitched bruit only in systole at the angle of the right jaw. A detailed neurologic examination is normal.
On questioning, the patient does not report any history of transient neurologic
deficits — specifically, no unilateral weakness or sensory symptoms, visual
disturbances, or speech or language difficulty. 追问病史，患者否认既往有神经系统异常（无TIA、感觉或运动异常、视野缺损、言语困难等）。非侵入性检查发现右侧颈动脉有70-80%的狭窄，可见不规则版块，狭窄处血流速度339cm每秒（快了），左侧颈动脉近端可见20%的狭窄。
Noninvasive testing of the carotid arteries reveals a stenosis of 70 to 80% of the proximal right carotid artery with an irregular plaque and peak velocity of 339 cm per second. There is 20% stenosis in the left proximal carotid artery.
Treatment Options
What kind of treatment would you find most appropriate for this patient? Three options are outlined and each is defended in a short essay by an expert in the management of carotid stenosis; read the essays and then cast your vote.
讨论：下列哪种治疗方法最适合该患者？第一、药物治疗（Medical Management），第二、颈动脉内膜剥脱术（Carotid Endarterectomy），第三、支架置入术（Carotid Stenting）。
Case Vignette（病例讨论）
A 67-year-old man with a history of hypertension and hyperlipidemia is seen for a
routine examination. His medications include hydrochlorothiazide (25 mg daily),
simvastatin (20 mg daily), and aspirin (81 mg daily). He drinks alcohol rarely and
does not smoke. 患者，67岁男性，偶有饮酒，不吸烟。既往有高血压和和高脂血症，目前口服氢氯噻嗪（25 mg、qd）、辛伐他丁（20mg、qd）和阿司匹林（81mg、qd）。体格检查：体重指数27，超重，血压140/85 mm Hg，心率72bpm，律齐。心脏检查正常，听诊右侧颈部下颌角处可闻及中度收缩性杂音，神经系统检查正常。
His body-mass index (the weight in kilograms divided by the square of the height in meters) is 27, consistent with overweight. His blood pressure is 140/85 mm Hg, and his heart rate is 72 beats per minute and regular. His cardiac examination is normal.
Auscultation of the neck shows normal carotid upstrokes but reveals a middle-pitched bruit only in systole at the angle of the right jaw. A detailed neurologic examination is normal.
On questioning, the patient does not report any history of transient neurologic
deficits — specifically, no unilateral weakness or sensory symptoms, visual
disturbances, or speech or language difficulty. 追问病史，患者否认既往有神经系统异常（无TIA、感觉或运动异常、视野缺损、言语困难等）。非侵入性检查发现右侧颈动脉有70-80%的狭窄，可见不规则版块，狭窄处血流速度339cm每秒（快了），左侧颈动脉近端可见20%的狭窄。
Noninvasive testing of the carotid arteries reveals a stenosis of 70 to 80% of the proximal right carotid artery with an irregular plaque and peak velocity of 339 cm per second. There is 20% stenosis in the left proximal carotid artery.
Treatment Options
What kind of treatment would you find most appropriate for this patient? Three options are outlined and each is defended in a short essay by an expert in the management of carotid stenosis; read the essays and then cast your vote.
讨论：下列哪种治疗方法最适合该患者？第一、药物治疗（Medical Management），第二、颈动脉内膜剥脱术（Carotid Endarterectomy），第三、支架置入术（Carotid Stenting）。
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