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1、ThenewenglandjournalofmedicineclinicalpracticeCarenG.Solomon,M.D.,M.P.H.,EditorCarotidStenosisJamesC.Grotta,M.D.ThisJournalfeaturebeginswithacasevignettehighlightingacommonclinicalproblem.Evidencesupportingvariousstrategiesisthenpresented,followedbyareviewofformalguidelines,when
2、theyexist.Thearticleendswiththeauthor’sclinicalrecommendations.A53-year-oldwomanwhosmokedandhadhypertensionhadbriefnumbnessoftherightsideofherbody.Sixmonthslater,aphasiaandrighthemiparesissuddenlydevel-oped,andtheyresolvedafter48hours.Computedtomographicangiography(CTA)showedlef
3、tinternal-carotid-arterystenosisof70%justdistaltothebifurcation.Mag-neticresonanceimaging(MRI)confirmedaleftfrontotemporalinfarctwithouthem-orrhagictransformationorcerebraledema.Cardiacevaluationwasnormal.Whatistheappropriatemanagementofthispatient’scarotidstenosis?TheClinicalPr
4、oblemCarotidarterydiseasecausesapproximately10to20%ofstrokes,andappropriateFromtheUniversityofTexasMedicalinterventionisimportantforsecondaryandpossiblyprimarystrokeprevention.SchoolatHouston.Addressreprintre-queststoDr.GrottaattheDepartmentofThedegreeofcarotidstenosisisthestron
5、gestdeterminantofstrokerisk.Neurology,UniversityofTexasMedicalSchoolatHouston,6431FanninSt.,7.044,AtherosclerosisHouston,TX77030,oratjames.c.grotta@uth.tmc.edu.Atherosclerosis,themostcommondiseaseaffectingthecarotidartery,occursmostfrequentlyatitsbifurcation(Fig.1Aand1B).Atheros
6、cleroticplaquescausesymp-NEnglJMed2013;369:1143-50.DOI:10.1056/NEJMcp1214999tomsmostoftenthroughdistalembolismtobranchesoftheretinalorcerebralCopyright©2013MassachusettsMedicalSociety.arteries;hemodynamicallysignificantluminalstenosismayalsoresultincriticalreductionofperfusion.M
7、ostemboliresultfromactivationofplateletsontheplaquesurface;lessfre-quently,theyresultfromcholesterolparticles.An“unstableplaque”withruptureofthecapmaycauseemboli.1Emboliinretinalarteriolesleadtotransientmon-Anaudioversionocularblindness(amaurosisfugax).2Emboliinthecerebralcircul
8、ationmostoftenofthisarticleislodgeinthemiddlece
