支架成形术治疗颅外段颈动脉狭窄的临床研究
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摘要
目的
探讨CAS术治疗颈动脉狭窄的风险因素,分析其有效性、安全性和技术可行性,总结CAS对不同人群差异的适应证选择和对并发症的预防及处理。
资料与方法
1.回顾性分析本院接受379侧CAS手术的颅外段颈动脉狭窄患者的人群特点、临床特征以及血管数据资料。
2.按疗效判定标准、术后早期不良事件发生情况、术后30天终点事件以及随访状况对CAS预后情况进行总结。
3.统计分析采用CHISS统计软件进行。将所有入选患者的人群基本特征、临床特点、血管数据资料及病例终点事件经采集赋值后进入数据库,统计方法采用单变量分析方法和多因素Logistic回归分析。单变量分析方法分析每一个变量和CAS术后早期不良事件之间的关系,Logistic回归分析评估患者各种因素对于CAS术后30天内终点事件(卒中、心肌梗死、死亡)发生概率间的相关性。
结果
1.技术成功率100%,程度由术前的(81±17)%减轻为术后的(18±9)%；患者NIHSS评分：术前中位数为5分,术后中位数为3分。
2.术后早期共发生并发症72件次,15例CAS手术发生两种或两种以上的并发症；术后30天内病例终点事件共发生27例次,总体发生率为7.12%,其中大卒中5例(1.32%),小卒中12例(3.17%),心梗(心肌梗死、心内膜下梗死各2例)4例(1.05%),死亡6例(1.58%)。
3.随访3月~3年,结果表明,CAS无手术相关性死亡发生,手术侧半球卒中共3例,占所有手术例数的0.79%,术后再狭窄(≥50%)共发生10例,发生率为2.63%。
4.单因素分析结果：高龄、糖尿病和心功能不全三个因素分别对术后早期并发症的发生率产生显著性差异(P<0.05)。多因素Logistic回归分析结果：无症状性颈动脉狭窄、糖尿病两个因素是术后30天终点事件(卒中、心肌梗死、死亡)发生的独立影响因素。
结论
1.有效性方面,从手术技术成功率、狭窄纠正情况、颈动脉狭窄症状改善情况以及术后随访结果等四个方面分析,CAS可有效纠正颈动脉管腔狭窄、提高脑血流灌注、预防卒中的发生。
2.安全性方面,高龄患者因其解剖学特点,可能会增加手术的难度；高龄患者术后更易发生血流动力学的紊乱从而有增加术后不良事件发生的风险；症状性颈动脉狭窄患者的危险度是无症状性颈动脉狭窄的2.56倍,强调易损斑块的概念和降脂治疗的重要性,极重度颈动脉狭窄不会增加术后不良事件的发生；糖尿病作为独立危险因素反映出糖尿病患者的降糖标准的普遍性与CAS围手术期对血糖调控的特殊性之间存在不确定性,从而增加了糖尿病患者术后高并发症的风险,特别对于合并糖尿病的脑梗死患者,CAS术后出血风险大增；有效确认梗死病灶完全修复、通过围手术期干预调整心、肾功能到一定水平,可在一定程度上降低手术风险,但需要进一步论证。
3.技术可行性分析结果表明,包括双重保护技术、高龄患者CAS的关键技术、特殊部位CAS技术、高分辨MR对易损斑块的确认技术、防治高灌注损伤的关键技术在内的所有技术的开展和研发,可有效减少手术并发症的发生,拓展手术范围。
Objective
To explore risk factors of CAS for the treatment of carotid artery stenosis. To analyze the efficacy、safety and technical feasibility. To summarize CAS on the indication of choice between different populations and the prevention of complications.
Data and Methods
1. Retrospective analysis of 379 side of the CAS in patients with extracranial carotid stenosis on population characteristics, clinical features and vascular data.
2. To summarize the prognosis of CAS according to criteria of efficacy, the incidence of early postoperative,30-days adverse events and the follow-up status.
3. Statistical analyses were performed using the CHISS package.All the basic characteristics of selected groups of patients, clinical characteristics, vascular data and complications entered into the database after assignment by the acquisition. Univariate analysis was performed to evaluate the impact of every variable on early postoperative adverse events, Logistic regression was used to reveal the relationship between a variety of factors and the 30-day stroke、MI(myocardial infarctions) and death rates.
Results
1. Technical success rate of 100% from preoperative stenosis (81±17)% to reduce the postoperative (18±9)%. Patients with NIHSS score:median preoperative 5 points and postoperative 3 points.
2. Early postoperative complications occurred 72 times,15 cases of CAS occurred two or more. The 30-day stroke、MI and death occurred 27 cases of times, the overall incidence rate was 7.12%, includingmajor stroke in 5 cases (1.32%), minor stroke in the 12 cases (3.17%), myocardial infarction (myocardial infarction, subendocardial infarction in 2 cases respectively) 4 cases (1.05%),6 deaths (1.58%).
3.3 month to 3 year follow-up results showed that no procedure-related death occurred, ipsilateral stroke occured in 3 cases(0.79%), restenosis (≥50%) occurred in 10patients(2.63%).
4. Univariate analysis showed age, diabetes and heart failure on the incidence of early postoperative complications had a respectively significant impact(p<0.05). Multivariate Logistic regression analysis revealed that asymptomatic stenosis (odds ratio[OR]= 0.39, p=0.0426)and diabetes([OR]= 3.38, p=0.0099) were significant predictors of the composite 30-days end point of MI,stroke and all-cause mortality.
Conclusion
1. In terms of CAS efficacy, CAS can be effective in restoring carotid artery stenosis, increased cerebral blood flow and prevent the occurrence of stroke according to technical success rate, stenosis remedy, improvement of symptoms, and postoperative follow-up results,
2. In terms of CAS safety, elderly patients because of its anatomical characteristics, may increase the difficulty of precedure; elderly patients are more likely to have hemodynamic disorders to increase the risk of adverse events. Risk of symptomatic carotid artery stenosis in patients with carotid artery stenosis is asymptomatic of 2.56 times, the concept of vulnerable plaque and the importance of lipid-lowering therapy must be stressed. Very severe carotid artery stenosis does not increase the incidence of adverse events. As an independent risk factor, not clear whether the blood glucose levels in diabetic patients for CAS perioperative period, thus, the diabetic increases the risk of postoperative complications,especially for stroke patients. To confirm infarction lesions were completely repaired effectively, to adjust perioperative cardiac and renal function to a certain level, can reduce the surgical risk to some extent, but further proof are needed.
3. In terms of technical feasibility of CAS, Including dual protection technology, the key technology of CAS in elder, the special part of CAS technology, the recognition technology of vulnerable plaque, the key control technology of high-reperfusion injury, all can effectively reduce complications and expand the scope of CAS.
探讨CAS术治疗颈动脉狭窄的风险因素,分析其有效性、安全性和技术可行性,总结CAS对不同人群差异的适应证选择和对并发症的预防及处理。
资料与方法
1.回顾性分析本院接受379侧CAS手术的颅外段颈动脉狭窄患者的人群特点、临床特征以及血管数据资料。
2.按疗效判定标准、术后早期不良事件发生情况、术后30天终点事件以及随访状况对CAS预后情况进行总结。
3.统计分析采用CHISS统计软件进行。将所有入选患者的人群基本特征、临床特点、血管数据资料及病例终点事件经采集赋值后进入数据库,统计方法采用单变量分析方法和多因素Logistic回归分析。单变量分析方法分析每一个变量和CAS术后早期不良事件之间的关系,Logistic回归分析评估患者各种因素对于CAS术后30天内终点事件(卒中、心肌梗死、死亡)发生概率间的相关性。
结果
1.技术成功率100%,程度由术前的(81±17)%减轻为术后的(18±9)%；患者NIHSS评分：术前中位数为5分,术后中位数为3分。
2.术后早期共发生并发症72件次,15例CAS手术发生两种或两种以上的并发症；术后30天内病例终点事件共发生27例次,总体发生率为7.12%,其中大卒中5例(1.32%),小卒中12例(3.17%),心梗(心肌梗死、心内膜下梗死各2例)4例(1.05%),死亡6例(1.58%)。
3.随访3月~3年,结果表明,CAS无手术相关性死亡发生,手术侧半球卒中共3例,占所有手术例数的0.79%,术后再狭窄(≥50%)共发生10例,发生率为2.63%。
4.单因素分析结果：高龄、糖尿病和心功能不全三个因素分别对术后早期并发症的发生率产生显著性差异(P<0.05)。多因素Logistic回归分析结果：无症状性颈动脉狭窄、糖尿病两个因素是术后30天终点事件(卒中、心肌梗死、死亡)发生的独立影响因素。
结论
1.有效性方面,从手术技术成功率、狭窄纠正情况、颈动脉狭窄症状改善情况以及术后随访结果等四个方面分析,CAS可有效纠正颈动脉管腔狭窄、提高脑血流灌注、预防卒中的发生。
2.安全性方面,高龄患者因其解剖学特点,可能会增加手术的难度；高龄患者术后更易发生血流动力学的紊乱从而有增加术后不良事件发生的风险；症状性颈动脉狭窄患者的危险度是无症状性颈动脉狭窄的2.56倍,强调易损斑块的概念和降脂治疗的重要性,极重度颈动脉狭窄不会增加术后不良事件的发生；糖尿病作为独立危险因素反映出糖尿病患者的降糖标准的普遍性与CAS围手术期对血糖调控的特殊性之间存在不确定性,从而增加了糖尿病患者术后高并发症的风险,特别对于合并糖尿病的脑梗死患者,CAS术后出血风险大增；有效确认梗死病灶完全修复、通过围手术期干预调整心、肾功能到一定水平,可在一定程度上降低手术风险,但需要进一步论证。
3.技术可行性分析结果表明,包括双重保护技术、高龄患者CAS的关键技术、特殊部位CAS技术、高分辨MR对易损斑块的确认技术、防治高灌注损伤的关键技术在内的所有技术的开展和研发,可有效减少手术并发症的发生,拓展手术范围。
Objective
To explore risk factors of CAS for the treatment of carotid artery stenosis. To analyze the efficacy、safety and technical feasibility. To summarize CAS on the indication of choice between different populations and the prevention of complications.
Data and Methods
1. Retrospective analysis of 379 side of the CAS in patients with extracranial carotid stenosis on population characteristics, clinical features and vascular data.
2. To summarize the prognosis of CAS according to criteria of efficacy, the incidence of early postoperative,30-days adverse events and the follow-up status.
3. Statistical analyses were performed using the CHISS package.All the basic characteristics of selected groups of patients, clinical characteristics, vascular data and complications entered into the database after assignment by the acquisition. Univariate analysis was performed to evaluate the impact of every variable on early postoperative adverse events, Logistic regression was used to reveal the relationship between a variety of factors and the 30-day stroke、MI(myocardial infarctions) and death rates.
Results
1. Technical success rate of 100% from preoperative stenosis (81±17)% to reduce the postoperative (18±9)%. Patients with NIHSS score:median preoperative 5 points and postoperative 3 points.
2. Early postoperative complications occurred 72 times,15 cases of CAS occurred two or more. The 30-day stroke、MI and death occurred 27 cases of times, the overall incidence rate was 7.12%, includingmajor stroke in 5 cases (1.32%), minor stroke in the 12 cases (3.17%), myocardial infarction (myocardial infarction, subendocardial infarction in 2 cases respectively) 4 cases (1.05%),6 deaths (1.58%).
3.3 month to 3 year follow-up results showed that no procedure-related death occurred, ipsilateral stroke occured in 3 cases(0.79%), restenosis (≥50%) occurred in 10patients(2.63%).
4. Univariate analysis showed age, diabetes and heart failure on the incidence of early postoperative complications had a respectively significant impact(p<0.05). Multivariate Logistic regression analysis revealed that asymptomatic stenosis (odds ratio[OR]= 0.39, p=0.0426)and diabetes([OR]= 3.38, p=0.0099) were significant predictors of the composite 30-days end point of MI,stroke and all-cause mortality.
Conclusion
1. In terms of CAS efficacy, CAS can be effective in restoring carotid artery stenosis, increased cerebral blood flow and prevent the occurrence of stroke according to technical success rate, stenosis remedy, improvement of symptoms, and postoperative follow-up results,
2. In terms of CAS safety, elderly patients because of its anatomical characteristics, may increase the difficulty of precedure; elderly patients are more likely to have hemodynamic disorders to increase the risk of adverse events. Risk of symptomatic carotid artery stenosis in patients with carotid artery stenosis is asymptomatic of 2.56 times, the concept of vulnerable plaque and the importance of lipid-lowering therapy must be stressed. Very severe carotid artery stenosis does not increase the incidence of adverse events. As an independent risk factor, not clear whether the blood glucose levels in diabetic patients for CAS perioperative period, thus, the diabetic increases the risk of postoperative complications,especially for stroke patients. To confirm infarction lesions were completely repaired effectively, to adjust perioperative cardiac and renal function to a certain level, can reduce the surgical risk to some extent, but further proof are needed.
3. In terms of technical feasibility of CAS, Including dual protection technology, the key technology of CAS in elder, the special part of CAS technology, the recognition technology of vulnerable plaque, the key control technology of high-reperfusion injury, all can effectively reduce complications and expand the scope of CAS.
引文
[1]DeBakey ME. Carotid endarterectomy revisited. J Endovasc Surg.1996,3:4.
[2]The North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med.1991,325:445-453.
[3]The European Carotid Surgery Trialists'Collaborative Group. MRC European Carotid Surgery Trial:interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet.1991,337:1235-1243.
[4]Regarding "carotid endarterectomy in SAPPHIRE-eligible high-risk patients: Implications for selecting patients for carotid angioplasty and stenting". Journal of Vascular Surgery.2004,40:595-596.
[5]Yadav J. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE).Chicago,Ill:American Heart Association; 2002.
[6]Gurm HS,Yadav JS, Fayad P, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med.2008,358:1572-1579.
[7]30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients:A randomized non-inferiority trial. Lancet. 2006,368:1239-1247.
[8]李宝民,郭梅,李生,等.经血管内支架成形术在颅内血管疾病的初步应用.中华外科杂志.2002,40：890-892.
[9]王君,李宝民,李生,等.血管内支架成形术治疗颅外段颈动脉狭窄.中华外科杂志.2009,47：415-418.
[10]Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:Part I. Circulation.2003, 108:1664-1672.
[11]Hatsukami TS, Ross R, Polissar NL, et al. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high resolution magnetic resonance imaging. Circulation.2000,102:959-964.
[12]Caplan LR. Brain embolism, revisited. Neurology.1993,43:1281-1287.
[13]Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol.1998, 55:1475-1482.
[14]Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS):a randomised trial. Lancet.2001,357:1729-1737.
[15]Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotidartery stenting versus endarterectomy in high-risk patients. N Engl J Med.2004,351:1493-1501.
[16]Roubin GS,New G,Iyer SS,et al. Immediate and late clinical outcomes of carotid artery stenting in symptomatic and asymptomatic carotid stenosis:a 5-year prospective analysis. Circulation.2001,103:523-537.
[17]李宝民,李生,周定标,等.应用支架成形术处理颈动脉系血管狭窄.解放军医学杂志,2002,27：668-670.
[18]Kearney M. Histopathology of in stent restenosis in patients with peripheral artery disease. Circulation.1997,15:1998-2002.
[19]王君,李宝民,李生,等.颈动脉支架植入术后血流动力学变化的相关因素分析.中国现代神经疾病杂志.2005,5：88-92.
[20]王君,李宝民,李生,等.经皮颈动脉狭窄血管内支架成形140例临床分析.中华神经外科杂志.2007,23：31-34.
[21]李宝民,王君,李生,等.经动脉内间断加压灌注治疗低灌注性脑缺血的初步探讨.中华老年心脑血管病杂志.2005,5：334-336.
[22]王君,李宝民,周典贵,等.探讨陈旧性脑梗死缺血脑区的影像学特点和加压灌注治疗.中华老年心脑血管病杂志.2007,9：446-449.
[23]CARESS Steering Committee. Carotid Revascularization Using Endarterectomy of Stenting Systems (CARESS):phase I clinical trial. J Endovasc Ther.2003,10:1021-1030
[24]Brott TG, Roberts J, Hobson RW, Hughes S. Carotid revascularization in 2004. Endovasc Today.2004,3:33-40.
[25]Lal BK, Brott TG. The carotid revascularization endarterectomy vs.Stenting trial completes randomization:Lessons learned and anticipated results. J Vasc Surg. 2009,50:1224-1231.
[26]Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg.2007,45:875-80.
[27]Lin SC, Trocciola SM, Rhee J, Dayal R, Chaer R, Morrissey NJ. Analysis of anatomic factors and age in patients undergoing carotid angioplasty and stenting. Ann Vasc Surg.2005,19:798-804.
[28]Groschel K, Ernemann U, Riecker A, et al. Incidence and risk factors for medical complications after carotid artery stenting. J Vasc Surg.2005,42:1101-1107.
[29]王利军,王大明,刘加春,等.老年人颈动脉狭窄支架置入术的血流动力学紊乱研究.中国医学影像技术.2007,23：784-787.
[30]Motamed C, Motamed-Kazerounian G, Merle JC, et al. Cardiac troponin assessment and late cardiac complications after carotid stenting or endarterectomy. J Vasc Surg.2005,41:769-774.
[31]Howell M, Krajcer Z, Dougherty K, et al. Corelation of periprocedural systolic blood pressure changes wit h neurological event s in high risk carotid stent patients. J Endovasc Ther.2002,9:810-816.
[32]Norris JW, Zhu CA, Bornstein NM, et al.Vascular risks of asymptomatic carotid stenosis.Stroke.1991,22:1485-1490.
[33]CASANOVA Study Group.Carotid surgery versus medical therapy in asymptomatic carotid stenosis.Stroke.1991,22:1229-1235.
[34]Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trail of carotid endarterectomy for asymptomatic carotid stenosis.Mayo Clin Proc.1992,67:513-518.
[35]Rakebrandt F, Crawford DC, Havard D, et al.Relationship between ultrasound texture classification images and histology of atherosclerotic plaque. Ultrasound Med Biol.2000,26:1393-1402.
[36]Goldberg AC,Ostlund RE Jr,Bateman JH,et al.Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs.Am J Cardiol.2006,97:376-379.
[37]Hatsukami TS, Ross R, Polissar NL, et al. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high resolution magnetic resonance imaging. Circulation.2000,102:959-964.
[38]Stead LG, Gilmore RM, Bellilio MF,et al.Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke.Neurocrit Care.2009,10:181-186.
[39]Cape SE, Hunt D, Malmberg K, et al.Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients:a systematic overview.Stroke.2001,32: 2426-2432.
[40]Wechsler LR,Roberts R,Furlan AJ,et al.Factors influencing outcome and treatment effect in PROACT II.Stroke.2003,34:1224-1229.
[41]Bruno A,Williams L S,Kent TA.How important is hyperglycemia during acute brain infarction?Neurologist.2004,10:195-200.
[42]Mooradian AD, Bernbaum M, Albert SG. Narrative review:a rational approach to starting insulin therapy.Ann Intern Med.2006,145:125-134.
[43]Grandin CB,Dupraz TP,Smith AM,et al.Which MR-Drived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements. Radiology.2002,223:361-370
[44]Debing E, Van den Brande P. Chronic renal insufficiency and risk of early mortality in patients undergoing carotid endarterectomy. Ann Vasc Surg.2006,20:609-613
[45]Ascher E, Marks NA, Schutzer RW, et al. Carotid endarterectomy in patients with chronic renal insufficiency:a recent series of 184 cases. J Vasc Surg.2005,41:24-29.
[46]Whitlow PL,Lylyk P.Londero H,et al.Carotid artery stenting protected with an emboli containment system.Stroke.2002,33:908-914.
[47]Gary M Ansel,Michael R Jaff.Carotid stenting with embolic protection: evolutionary advances.Expert Rev.Med.Devices.2008,5:427-436.
[48]李慎茂,缪中荣,朱凤水,等.颈动脉支架治疗颈动脉狭窄的并发症.介入放射学杂志.2007,16：291-294.
[49]李生,李宝民,曹向宇,等.老年颅外段颈动脉狭窄患者的血管内介入治疗相关问题的探讨.中华老年心脑血管病杂志.2005,7：30-32.
[50]王君,李宝民,李生,等.血管内支架成形术治疗颅外段颈动脉狭窄.中华外科杂志.2009,47：415-418.
[51]李生,李宝民,周定标,等。对侧颈动脉闭塞患者颈动脉成形支架置入术的临床分析.中华外科杂志.2010,49：303-306.
[52]Yuan C, Zhang SX, Polissar NL, et al. Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation.2002,105:181-185.
[53]雷静,高培毅.高危颈动脉粥样硬化斑块的磁共振成像研究.中国卒中杂志.2006,1：488-493.
[1]Kazmierski MK. Stenosis of the carotid arteries. Wiad Lek.2003,56:260-265.
[2]Mead GE, Murray H, Farrell A, et al. Pilot study of carotid surgery for acute stroke. Br J Surg.1997,84:990-992.
[3]雷静,高培毅.高危颈动脉粥样硬化斑块的磁共振成像研究.中国卒中杂志.2006,1：488-493.
[4]Clarke SE, Beletsky V, Ham mond RR, et al. Validation of automatically classified magnetic resonance images for carotid plaque compositional analysis. Stroke.2006, 37:93-97.
[5]Hofman JM, Branderhorst WJ, ten Eikelder HM, et al. Quantification of atherosclerotic plaque components using in vivo MRI and supervised classifiers. Magn Reson Med.2006,55:790-799.
[6]Kolodgie FD, Gold HK, Burke AP, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med.2003,349:2316-2325.
[7]Saam T, Cai J, Ma L, et al. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology.2006,240: 464-472.
[8]Nighoghossian N, Derex L, Douek P, et al. The vulnerable carotid artery plaque: current imaging methods and newperspectives. Stroke.2005,36:2764-2772.
[9]Hatsukami TS, Ross R, Polissar NL, et al. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high resolution magnetic resonance imaging. Circulation.2000,102:959-964.
[10]Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:Part I. Circulation.2003, 108:1664-1672.
[11]Takaya N, Yuan C, Chu B, et al. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events:a prospective assessment with MRI--initial results. Stroke.2006,37:818-823.
[12]Schulz UGR, Rothwell PM. Major variation in carotid bifurcation anatomy:a possible risk factor for plaque development? Stroke.2001,32:2522-2529.
[13]Zarins CK, Giddens DP, Bharadvaj BK, et al. Carotid bifurcation atherosclerosis: quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circulation Res.1983,53:502-514.
[14]Niwa K, Kado T, Sakai J, et al. The effects of a shear flow on the uptake of LDL and acetylated LDL by an EC monoculture and an EC-SMC coculture. Ann Biomed Eng.2004,32:537-543.
[15]Cheng C, Tempel D, van Haperen R, et al. Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress. Circulation. 2006,113:2744-2753.
[16]Lovett JK, Rothwell PM. Site of carotid plaque ulceration in relation to direction of blood flow:an angiographic and pathological study. Cerebrovasc Dis.2003,16:369-375.
[17]Nonaka T, Oka S, Miyata K, et al. Prediction of prolonged postprocedural hypotension after carotid artery stenting. Neurosurgery.2005,57:472-477.
[18]Hatsukami TS, Ferguson MS, Beach KW, et al.Carotid plaque morphology and clinical events.Stroke.1997,28:95-100
[19]他汀类药物预防缺血性卒中/短暂性脑缺血发作专家组.他汀类药物预防缺血性卒中/短暂性脑缺血发作的专家建议.中华内科杂志.2007,46：81-82.
[20]Stead LG, Gilmore RM, Bellilio MF,et al.Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke.Neurocrit Care.2009,10:181-186.
[21]Cape SE, Hunt D, Malmberg K, et al.Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients:a systematic overview.Stroke.2001,32:2426-2432.
[22]Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for Asymptomatic Carotid Artery Stenosis. JAMA.1995,273: 1421-1461.
[23]Logman JF,Heeg BM,Herlitz J,et al.Costs and consequences of clopidogrel versus aspirin for secondary prevention of ischaemic events in (high-risk) atherosclerotic patients in Sweden:a lifetime model based on the CAPRIE trial and high-risk CAPRIE subpopulations.Appl Health Econ Health Policy.2010,8:251-265.
[24]Menon BK,Frankel MR,Liang L,et al. Rapid change in prescribing behavior in hospitals participating in get with the guidelines-stroke after release of the management of atherothrombosis with clopidogrel in high-risk patients (MATCH) clinical trial results. Stroke.2010,41:2094-2097.
[25]Rouhl RP,Lodder J.ESPRIT:is aspirin plus dipyridamole superior to aspirin alone in TIA or minor stroke patients?Expert Rev Neurother.2008,8:1661-1665.
[26]Halkes PH,Algra A.Anticoagulants, aspirin and dipyridamole in the secondary prevention of cerebral ischaemia:which is the best for which patient? Cerebrovasc Dis(S).2007,24:107-111.
[27]Goldberg AC,Ostlund RE Jr,Bateman JH,et al.Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs.Am J Cardiol. 2006,97:376-379.
[28]Hoogwerf BJ,Young JB.The HOPE study. Ramipril lowered cardiovascular risk, but vitamin E did not.Cleve Clin J Med.2000,67:287-293.
[29]Crisby M,Nordin-Fredriksson G, Shah PK,et al. Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques:implications for plaque stabilization. Circulation.2001,107:926-933.
[30]DeBakey ME. Carotid endarterectomy revisited. J Endovasc Surg.1996,3:4.
[31]The North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med.1991,325:445-453.
[32]Barnett HJ, Taylor DW, Eliasziw M,et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North Am Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med.1998,339:1415-1425.
[33]The European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial:interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet.1991,337:1235-1243.
[34]The European Carotid Surgery Trialists'Collaborative Group. Endarterectomy for moderate symptomatic carotid stenosis:interim results from the MRC European Carotid Surgery Trial.Lancet.1996,347:1591-1593.
[35]The European Carotid Surgery Trialists'Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis:final results of the MRC European Carotid Surgery Trial (ECST). Lancet.1998,351:1379-1387.
[36]Goldstein LB, Hasselblad V, Matchar DB, et al.Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic carotid artery stenosis.Neurology.1995,45:1965-1970
[37]Rothwell P, Warlow C. Is self-audit reliable? Lancet.1995,346:1623
[38]Kerber CW, Cromwell LD, Loehden OL. Catheter dilatation of proximal carotid stenosis during distal bifurcation endarterectomy. AJNR Am J Neuroradiol. 1980,1:348-349.
[39]Markus HS, Clifton A, Buckenham T, et al. Carotid angioplasty. Detection of embolic signals during and after the procedur. Stroke.1994,25:2403-2406.
[40]Mathias K.Stent placement in arteriosclerotic disease of the internal carotid artery.J Intern Cariol.1997,10:469-477.
[41]李宝民,李生,王君,等.颈动脉狭窄支架成形术中应对血流动力学变化的临床探讨.中华外科杂志.2007,45：230-231.
[42]凌锋,焦力群.颈动脉内膜剥脱术与支架成形术对颈动脉粥样硬化性狭窄治疗的初步研究.中国脑血管病杂志.2006,3：4-8.
[43]王君,李宝民,李生,等.血管内支架成形术治疗颅外段颈动脉狭窄.中华外科杂志.2009,47：415-418.
[44]李宝民.粥样硬化性颈动脉狭窄及外科和血管内治疗.中华老年心脑血管病杂志.2007,4：223-224.
[45]李宝民.颈动脉狭窄成形术中的支架和脑保护装置选择.中国医疗器械信息.2005,8：5-8.
[46]Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotidartery stenting versus endarterectomy in high-risk patients. N Engl J Med.2004,351:1493-1501.
[47]Regarding "carotid endarterectomy in SAPPHIRE-eligible high-risk patients: Implications for selecting patients for carotid angioplasty and stenting".Journal of Vascular Surgery.2004,40:595-596.
[2]The North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med.1991,325:445-453.
[3]The European Carotid Surgery Trialists'Collaborative Group. MRC European Carotid Surgery Trial:interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet.1991,337:1235-1243.
[4]Regarding "carotid endarterectomy in SAPPHIRE-eligible high-risk patients: Implications for selecting patients for carotid angioplasty and stenting". Journal of Vascular Surgery.2004,40:595-596.
[5]Yadav J. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE).Chicago,Ill:American Heart Association; 2002.
[6]Gurm HS,Yadav JS, Fayad P, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med.2008,358:1572-1579.
[7]30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients:A randomized non-inferiority trial. Lancet. 2006,368:1239-1247.
[8]李宝民,郭梅,李生,等.经血管内支架成形术在颅内血管疾病的初步应用.中华外科杂志.2002,40：890-892.
[9]王君,李宝民,李生,等.血管内支架成形术治疗颅外段颈动脉狭窄.中华外科杂志.2009,47：415-418.
[10]Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:Part I. Circulation.2003, 108:1664-1672.
[11]Hatsukami TS, Ross R, Polissar NL, et al. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high resolution magnetic resonance imaging. Circulation.2000,102:959-964.
[12]Caplan LR. Brain embolism, revisited. Neurology.1993,43:1281-1287.
[13]Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol.1998, 55:1475-1482.
[14]Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS):a randomised trial. Lancet.2001,357:1729-1737.
[15]Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotidartery stenting versus endarterectomy in high-risk patients. N Engl J Med.2004,351:1493-1501.
[16]Roubin GS,New G,Iyer SS,et al. Immediate and late clinical outcomes of carotid artery stenting in symptomatic and asymptomatic carotid stenosis:a 5-year prospective analysis. Circulation.2001,103:523-537.
[17]李宝民,李生,周定标,等.应用支架成形术处理颈动脉系血管狭窄.解放军医学杂志,2002,27：668-670.
[18]Kearney M. Histopathology of in stent restenosis in patients with peripheral artery disease. Circulation.1997,15:1998-2002.
[19]王君,李宝民,李生,等.颈动脉支架植入术后血流动力学变化的相关因素分析.中国现代神经疾病杂志.2005,5：88-92.
[20]王君,李宝民,李生,等.经皮颈动脉狭窄血管内支架成形140例临床分析.中华神经外科杂志.2007,23：31-34.
[21]李宝民,王君,李生,等.经动脉内间断加压灌注治疗低灌注性脑缺血的初步探讨.中华老年心脑血管病杂志.2005,5：334-336.
[22]王君,李宝民,周典贵,等.探讨陈旧性脑梗死缺血脑区的影像学特点和加压灌注治疗.中华老年心脑血管病杂志.2007,9：446-449.
[23]CARESS Steering Committee. Carotid Revascularization Using Endarterectomy of Stenting Systems (CARESS):phase I clinical trial. J Endovasc Ther.2003,10:1021-1030
[24]Brott TG, Roberts J, Hobson RW, Hughes S. Carotid revascularization in 2004. Endovasc Today.2004,3:33-40.
[25]Lal BK, Brott TG. The carotid revascularization endarterectomy vs.Stenting trial completes randomization:Lessons learned and anticipated results. J Vasc Surg. 2009,50:1224-1231.
[26]Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg.2007,45:875-80.
[27]Lin SC, Trocciola SM, Rhee J, Dayal R, Chaer R, Morrissey NJ. Analysis of anatomic factors and age in patients undergoing carotid angioplasty and stenting. Ann Vasc Surg.2005,19:798-804.
[28]Groschel K, Ernemann U, Riecker A, et al. Incidence and risk factors for medical complications after carotid artery stenting. J Vasc Surg.2005,42:1101-1107.
[29]王利军,王大明,刘加春,等.老年人颈动脉狭窄支架置入术的血流动力学紊乱研究.中国医学影像技术.2007,23：784-787.
[30]Motamed C, Motamed-Kazerounian G, Merle JC, et al. Cardiac troponin assessment and late cardiac complications after carotid stenting or endarterectomy. J Vasc Surg.2005,41:769-774.
[31]Howell M, Krajcer Z, Dougherty K, et al. Corelation of periprocedural systolic blood pressure changes wit h neurological event s in high risk carotid stent patients. J Endovasc Ther.2002,9:810-816.
[32]Norris JW, Zhu CA, Bornstein NM, et al.Vascular risks of asymptomatic carotid stenosis.Stroke.1991,22:1485-1490.
[33]CASANOVA Study Group.Carotid surgery versus medical therapy in asymptomatic carotid stenosis.Stroke.1991,22:1229-1235.
[34]Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trail of carotid endarterectomy for asymptomatic carotid stenosis.Mayo Clin Proc.1992,67:513-518.
[35]Rakebrandt F, Crawford DC, Havard D, et al.Relationship between ultrasound texture classification images and histology of atherosclerotic plaque. Ultrasound Med Biol.2000,26:1393-1402.
[36]Goldberg AC,Ostlund RE Jr,Bateman JH,et al.Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs.Am J Cardiol.2006,97:376-379.
[37]Hatsukami TS, Ross R, Polissar NL, et al. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high resolution magnetic resonance imaging. Circulation.2000,102:959-964.
[38]Stead LG, Gilmore RM, Bellilio MF,et al.Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke.Neurocrit Care.2009,10:181-186.
[39]Cape SE, Hunt D, Malmberg K, et al.Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients:a systematic overview.Stroke.2001,32: 2426-2432.
[40]Wechsler LR,Roberts R,Furlan AJ,et al.Factors influencing outcome and treatment effect in PROACT II.Stroke.2003,34:1224-1229.
[41]Bruno A,Williams L S,Kent TA.How important is hyperglycemia during acute brain infarction?Neurologist.2004,10:195-200.
[42]Mooradian AD, Bernbaum M, Albert SG. Narrative review:a rational approach to starting insulin therapy.Ann Intern Med.2006,145:125-134.
[43]Grandin CB,Dupraz TP,Smith AM,et al.Which MR-Drived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements. Radiology.2002,223:361-370
[44]Debing E, Van den Brande P. Chronic renal insufficiency and risk of early mortality in patients undergoing carotid endarterectomy. Ann Vasc Surg.2006,20:609-613
[45]Ascher E, Marks NA, Schutzer RW, et al. Carotid endarterectomy in patients with chronic renal insufficiency:a recent series of 184 cases. J Vasc Surg.2005,41:24-29.
[46]Whitlow PL,Lylyk P.Londero H,et al.Carotid artery stenting protected with an emboli containment system.Stroke.2002,33:908-914.
[47]Gary M Ansel,Michael R Jaff.Carotid stenting with embolic protection: evolutionary advances.Expert Rev.Med.Devices.2008,5:427-436.
[48]李慎茂,缪中荣,朱凤水,等.颈动脉支架治疗颈动脉狭窄的并发症.介入放射学杂志.2007,16：291-294.
[49]李生,李宝民,曹向宇,等.老年颅外段颈动脉狭窄患者的血管内介入治疗相关问题的探讨.中华老年心脑血管病杂志.2005,7：30-32.
[50]王君,李宝民,李生,等.血管内支架成形术治疗颅外段颈动脉狭窄.中华外科杂志.2009,47：415-418.
[51]李生,李宝民,周定标,等。对侧颈动脉闭塞患者颈动脉成形支架置入术的临床分析.中华外科杂志.2010,49：303-306.
[52]Yuan C, Zhang SX, Polissar NL, et al. Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation.2002,105:181-185.
[53]雷静,高培毅.高危颈动脉粥样硬化斑块的磁共振成像研究.中国卒中杂志.2006,1：488-493.
[1]Kazmierski MK. Stenosis of the carotid arteries. Wiad Lek.2003,56:260-265.
[2]Mead GE, Murray H, Farrell A, et al. Pilot study of carotid surgery for acute stroke. Br J Surg.1997,84:990-992.
[3]雷静,高培毅.高危颈动脉粥样硬化斑块的磁共振成像研究.中国卒中杂志.2006,1：488-493.
[4]Clarke SE, Beletsky V, Ham mond RR, et al. Validation of automatically classified magnetic resonance images for carotid plaque compositional analysis. Stroke.2006, 37:93-97.
[5]Hofman JM, Branderhorst WJ, ten Eikelder HM, et al. Quantification of atherosclerotic plaque components using in vivo MRI and supervised classifiers. Magn Reson Med.2006,55:790-799.
[6]Kolodgie FD, Gold HK, Burke AP, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med.2003,349:2316-2325.
[7]Saam T, Cai J, Ma L, et al. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology.2006,240: 464-472.
[8]Nighoghossian N, Derex L, Douek P, et al. The vulnerable carotid artery plaque: current imaging methods and newperspectives. Stroke.2005,36:2764-2772.
[9]Hatsukami TS, Ross R, Polissar NL, et al. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high resolution magnetic resonance imaging. Circulation.2000,102:959-964.
[10]Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:Part I. Circulation.2003, 108:1664-1672.
[11]Takaya N, Yuan C, Chu B, et al. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events:a prospective assessment with MRI--initial results. Stroke.2006,37:818-823.
[12]Schulz UGR, Rothwell PM. Major variation in carotid bifurcation anatomy:a possible risk factor for plaque development? Stroke.2001,32:2522-2529.
[13]Zarins CK, Giddens DP, Bharadvaj BK, et al. Carotid bifurcation atherosclerosis: quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circulation Res.1983,53:502-514.
[14]Niwa K, Kado T, Sakai J, et al. The effects of a shear flow on the uptake of LDL and acetylated LDL by an EC monoculture and an EC-SMC coculture. Ann Biomed Eng.2004,32:537-543.
[15]Cheng C, Tempel D, van Haperen R, et al. Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress. Circulation. 2006,113:2744-2753.
[16]Lovett JK, Rothwell PM. Site of carotid plaque ulceration in relation to direction of blood flow:an angiographic and pathological study. Cerebrovasc Dis.2003,16:369-375.
[17]Nonaka T, Oka S, Miyata K, et al. Prediction of prolonged postprocedural hypotension after carotid artery stenting. Neurosurgery.2005,57:472-477.
[18]Hatsukami TS, Ferguson MS, Beach KW, et al.Carotid plaque morphology and clinical events.Stroke.1997,28:95-100
[19]他汀类药物预防缺血性卒中/短暂性脑缺血发作专家组.他汀类药物预防缺血性卒中/短暂性脑缺血发作的专家建议.中华内科杂志.2007,46：81-82.
[20]Stead LG, Gilmore RM, Bellilio MF,et al.Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke.Neurocrit Care.2009,10:181-186.
[21]Cape SE, Hunt D, Malmberg K, et al.Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients:a systematic overview.Stroke.2001,32:2426-2432.
[22]Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for Asymptomatic Carotid Artery Stenosis. JAMA.1995,273: 1421-1461.
[23]Logman JF,Heeg BM,Herlitz J,et al.Costs and consequences of clopidogrel versus aspirin for secondary prevention of ischaemic events in (high-risk) atherosclerotic patients in Sweden:a lifetime model based on the CAPRIE trial and high-risk CAPRIE subpopulations.Appl Health Econ Health Policy.2010,8:251-265.
[24]Menon BK,Frankel MR,Liang L,et al. Rapid change in prescribing behavior in hospitals participating in get with the guidelines-stroke after release of the management of atherothrombosis with clopidogrel in high-risk patients (MATCH) clinical trial results. Stroke.2010,41:2094-2097.
[25]Rouhl RP,Lodder J.ESPRIT:is aspirin plus dipyridamole superior to aspirin alone in TIA or minor stroke patients?Expert Rev Neurother.2008,8:1661-1665.
[26]Halkes PH,Algra A.Anticoagulants, aspirin and dipyridamole in the secondary prevention of cerebral ischaemia:which is the best for which patient? Cerebrovasc Dis(S).2007,24:107-111.
[27]Goldberg AC,Ostlund RE Jr,Bateman JH,et al.Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs.Am J Cardiol. 2006,97:376-379.
[28]Hoogwerf BJ,Young JB.The HOPE study. Ramipril lowered cardiovascular risk, but vitamin E did not.Cleve Clin J Med.2000,67:287-293.
[29]Crisby M,Nordin-Fredriksson G, Shah PK,et al. Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques:implications for plaque stabilization. Circulation.2001,107:926-933.
[30]DeBakey ME. Carotid endarterectomy revisited. J Endovasc Surg.1996,3:4.
[31]The North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med.1991,325:445-453.
[32]Barnett HJ, Taylor DW, Eliasziw M,et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North Am Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med.1998,339:1415-1425.
[33]The European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial:interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet.1991,337:1235-1243.
[34]The European Carotid Surgery Trialists'Collaborative Group. Endarterectomy for moderate symptomatic carotid stenosis:interim results from the MRC European Carotid Surgery Trial.Lancet.1996,347:1591-1593.
[35]The European Carotid Surgery Trialists'Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis:final results of the MRC European Carotid Surgery Trial (ECST). Lancet.1998,351:1379-1387.
[36]Goldstein LB, Hasselblad V, Matchar DB, et al.Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic carotid artery stenosis.Neurology.1995,45:1965-1970
[37]Rothwell P, Warlow C. Is self-audit reliable? Lancet.1995,346:1623
[38]Kerber CW, Cromwell LD, Loehden OL. Catheter dilatation of proximal carotid stenosis during distal bifurcation endarterectomy. AJNR Am J Neuroradiol. 1980,1:348-349.
[39]Markus HS, Clifton A, Buckenham T, et al. Carotid angioplasty. Detection of embolic signals during and after the procedur. Stroke.1994,25:2403-2406.
[40]Mathias K.Stent placement in arteriosclerotic disease of the internal carotid artery.J Intern Cariol.1997,10:469-477.
[41]李宝民,李生,王君,等.颈动脉狭窄支架成形术中应对血流动力学变化的临床探讨.中华外科杂志.2007,45：230-231.
[42]凌锋,焦力群.颈动脉内膜剥脱术与支架成形术对颈动脉粥样硬化性狭窄治疗的初步研究.中国脑血管病杂志.2006,3：4-8.
[43]王君,李宝民,李生,等.血管内支架成形术治疗颅外段颈动脉狭窄.中华外科杂志.2009,47：415-418.
[44]李宝民.粥样硬化性颈动脉狭窄及外科和血管内治疗.中华老年心脑血管病杂志.2007,4：223-224.
[45]李宝民.颈动脉狭窄成形术中的支架和脑保护装置选择.中国医疗器械信息.2005,8：5-8.
[46]Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotidartery stenting versus endarterectomy in high-risk patients. N Engl J Med.2004,351:1493-1501.
[47]Regarding "carotid endarterectomy in SAPPHIRE-eligible high-risk patients: Implications for selecting patients for carotid angioplasty and stenting".Journal of Vascular Surgery.2004,40:595-596.
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