Изменение подходов к лечению стеноза внутренней сонной артерии
https://doi.org/10.21518/akh2025-007
Аннотация
Целью данного обзора являются представление и обсуждение научной литературы для обоснования принятия решений оптимального выбора метода профилактики и лечения пациентов с атеросклеротическим стенозом внутренней сонной артерии. Анализу подвергнута эволюция подходов в лечении заболевания за последние 3–4 десятилетия. Приведено обобщение доказательной базы относительно эффективности, безопасности хирургических и медикаментозных методов профилактики инсульта у симптомных и асимптомных больных со стенозом внутренней сонной артерии. Сделаны выводы относительно текущих приоритетов в выборе профилактики инсульта у больных со стенозом внутренней сонной артерии. В обзоре анализируются текущие рандомизированные исследования и объясняется, почему они вряд ли определят рутинные показания для различных операций на сонной артерии. Ранее проведенные рандомизированные исследования показали эффективность каротидной эндартерэктомии в снижении риска инсульта. Однако не все пациенты получили пользу от вмешательства, особенно бессимптомные больные. У каждого конкретного пациента обычно невозможно быть уверенным в причине инсульта или транзиторных ишемических атак. Определение факторов риска и вероятности ишемического события более применимо в диагностике и лечении. Обсуждаются соответствующие мировые рекомендации относительно вмешательств на сонных артериях, в том числе способы их улучшения. Краеугольным камнем профилактики инсульта является оптимальная лекарственная терапия, поскольку эта процедура неинвазивна и защищает от тяжелых осложнений атеросклероза в различных сосудистых бассейнах у больных в группе риска. Остается важным вопрос, приносит ли хирургическое вмешательство на сонной артерии пользу пациенту в современную эпоху, и если да, то для кого?
Об авторе
Н. Г. Хорев
Алтайский государственный медицинский университет
Россия
Россия
Хорев Николай Германович, д.м.н., профессор, заведующий кафедрой кардиологии и сердечно-сосудистой хирургии с курсом дополнительного образования,
656038, Барнаул, проспект Ленина, д. 40;
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Рецензия
Для цитирования:
Хорев Н.Г. Изменение подходов к лечению стеноза внутренней сонной артерии. Амбулаторная хирургия. 2025;22(1):278-286. https://doi.org/10.21518/akh2025-007
For citation:
Khorev N.G. A shift of treatment approaches in internal carotid artery stenosis. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2025;22(1):278-286. (In Russ.) https://doi.org/10.21518/akh2025-007
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