2015年 · 第95卷第24期

Carotid endarterectomy (CEA) has a history of more than 60 years and is still recognized as the "gold standard" for the treatment of carotid arteriosclerosis and stenosis to prevent stroke^[1]。 Over 60 years of development, CEA has evolved four different surgical procedures, each with its own advantages and disadvantages. At present, most domestic centers still use in-situ incision and continuous suture, which is not commonly used internationally.

Stroke is an ancient disease that endangers human health, and it is still one of the main diseases that cause human death and disability. The human exploration of the cause of this disease has never stopped, but it was not until more than 60 years ago that scholars first recognized the relationship between stroke and carotid artery stenosis^[1], and gave birth to a brand-new treatment-carotid endarterectomy (CEA). After more than half a century of development, this operation has matured, and through a series of clinical trials in the 1990s, it has achieved the gold standard status for the treatment of carotid artery stenosis and the prevention of stroke. However, a technological revolution in the field of vascular disease treatment in the late 20th century opened an unprecedented new chapter for doctors. The newly born endovascular/interventional technology has become a powerful weapon for the treatment of vascular diseases with its minimally invasive and efficient characteristics. At present, it has become the mainstream technology in the field of coronary atherosclerotic heart disease treatment, and has also made great achievements in the field of carotid artery. Looking back at the development history of carotid artery stenting (CAS), it is not difficult to find that this new treatment has challenged the gold standard status of endarterectomy since its birth, and started a series of controlled studies with endarterectomy. Among them, the recognized milestone study is the CREST study published in 2010, which proved for the first time that there is no significant difference in the safety and efficacy of carotid artery stenting and endarterectomy in the treatment of carotid artery stenosis, which provides strong support for carotid artery stenting to become one of the preferred methods for the treatment of carotid artery stenosis, and promotes this technology to enter the mainstream guidelines.

Ischemic stroke is an important fatal and disabling factor. Once ischemic stroke occurs, the risk of recurrent ischemic events and death (recurrent stroke and myocardial infarction, etc.) is significantly increased, and atherosclerosis at the bifurcation of common carotid artery is one of the main causes of recurrent ischemic stroke^[1]。

The diagnosis of lower extremity ASO must be established by a combination of medical history inquiry, physical examination and related special examinations.

systemic sclerosis (SSc) is a connective tissue disease characterized by microvascular disease, tissue fibrosis and immune system activation. The prevalence rate is only 7/1 million ~489/1 million, according to foreign literature^[1]There is no relevant data in China. In the early stage of the disease, there is often only Raynaud's phenomenon, and patients often can't get timely diagnosis and treatment. In a Canadian cohort study, patients were diagnosed with SSc on average 5 years after the onset of Raynaud's phenomenon^[2]。 However, in the later stage of the disease, serious multi-system involvement can occur, such as gastroesophageal reflux disease, pulmonary interstitial disease, pulmonary hypertension, diastolic dysfunction, renal crisis, etc., which has a high disability rate and mortality rate, which seriously affects the quality of life of patients^[3]。 Early diagnosis and early treatment of this disease are particularly critical.