血管疏通术成为治疗颈动脉栓塞的有效手段

The CREST trial that compared traditional surgery with less-invasive stenting to clear dangerously clogged carotid arteries（颈动脉） in the neck is being called "seminal（种子的，生殖的） and robust." The Carotid Revascularization（血管再生） Endarterectomy（动脉内膜切除术） vs. Stenting Trial (CREST) found that the safety and efficacy of both procedures are roughly equal. The trial, conducted throughout the United States and Canada, is one of the largest randomized stroke prevention trials ever.

Loyola University Medical Center is among the centers that participated in CREST.

"Our multidisciplinary（有关各种学问的） team enrolled patients in both arms of this seminal and robust trial," said Dr. José Biller, one of the principal investigators at Loyola. "The data obtained at Loyola and other centers now will better inform doctors and patients about the relative benefits and risks of endarterectomy and stenting." Biller is chairman of the Department of Neurology at Loyola University Chicago Stritch School of Medicine. The other principal investigator at Loyola is Dr. Fred Leya, director of the cardiac catheterization（心导管插入术） lab.

Results were announced Feb. 26 at the 2010 International Stroke Conference in San Antonio. The study was funded by the National Institute of Neurological Disorders and Stroke and led by researchers at the Mayo Clinic in Jacksonville, Fla and the University of Medicine and Dentistry of New Jersey in Newark.

Carotid arteries on each side of the neck supply blood to the brain. As a patient ages, plaque（血小板） can build up, causing the artery to stiffen and narrow. A patient can suffer a stroke if the artery becomes completely blocked. Or, bits of plaque can break off and travel to the brain and cause a mini stroke called a transient ischemic attack (TIA短暂性脑缺血).

The traditional gold standard treatment is an endartectomy. A surgeon peels out the plaque deposit by removing the inner lining of the clogged artery. In the newer stenting procedure, a surgeon uses a catheter（导管） to deploy a stent (mesh tube). The stent expands inside the artery to increase blood flow.

CREST followed 2,502 participants, who were randomly assigned to receive an endarterectomy or a stenting. The overall safety and efficacy of the two procedures was largely the same. However, there were more heart attacks in the surgical group and more strokes in the stenting group.

"Both procedures are very safe and effective," said Dr. Mamdouh Bakhos, who performed endarterectomies in the trial. "Depending on a patient's age and medical condition, one procedure can have an advantage over the other. At Loyola, we offer both choices to patients." Bakhos is chairman of the Department of Thoracic and Cardiovascular Surgery.

Other Loyola physicians participating in the trial were Drs. Bernadette Aulivola and Peter Kalman, who perform endarterectomies; Drs. Robert Dieter and Fred Leya, who perform stenting procedures and neurologists Dr. Michael Schneck and Rima Dafer.

"The treatment strategy should be individualized to each patient, and take into consideration such factors as the patient's age and the type of blockage（封锁，堵塞） ," Dieter said. "It also is very important to consider how much experience the hospital and the physician have in performing each procedure."