《国际循环》：您是欧洲卒中大会的创立者之一，能否为我们简要介绍本届ESC年会的热点？

    <International Circulation>: As one of the founding members of the European Stroke Conference， could you please summarize the main highlights of this years meeting?
 

    Hennerici教授：在促进我们对卒中的管理方面，本届ESC大会最热的两个讲题是CREST试验和ACES试验，这是两项非常重要的试验。其结果会同时分别发表在《新英格兰医学杂志》和《柳叶刀》，这是颈动脉疾病治疗领域的重大进展。CREST试验将有助于我们进一步了解颈动脉疾病的治疗。关于选择内膜切除术还是介入治疗，已经争论了十几年。目前的研究以及最新的CREST试验均支持颈动脉内膜切除术仍然是颈动脉疾病治疗的金标准。此外，对于60岁以下患者，介入治疗看起来与内膜切除术疗效相近，因此可以作为这些患者的治疗选择。但是，60岁以上的老年患者还是应当首选颈动脉内膜切除术。最佳药物治疗是否与介入治疗或外科治疗等效？目前还没有明确的答案。现有试验均无法解答这一问题。去年，我们在欧洲开展了一项II期临床试验。该试验纳入无症状性颈动脉狭窄患者，设有最佳药物治疗、介入治疗和颈动脉内膜切除术三个治疗组，该试验将告诉我们在药物治疗基础上，是否需要进一步行手术或介入治疗。但是，该研究的结果至少要6~7年后才能揭晓，需要等待很长时间。
    本届ESC大会的另一个热点是ACES试验，目的是观察不合并卒中或短暂性脑缺血发作（TIA）的无症状性颈动脉疾病患者的诊断。这些患者是否应当治疗？怎么治疗？研究者应用超声检测大脑中动脉的微栓子作为颈动脉狭窄活动的预测指标。结果显示，大脑中动脉的微栓子是患者卒中风险较高的一个很好的预测指标。假如有100例无症状性颈动脉疾病患者，多普勒超声显示5例患者有微栓子信号，那么没有微栓子信号的其余95例患者发生卒中或TIA的风险很低。显然，这些患者不应当接受手术治疗或介入治疗。只有那5%有微栓子信号的患者可能从手术或介入治疗中获益。这是对有卒中风险的患者实施个体化治疗的另一个好的例子。

    Prof. Hennerici: I think two of the most significant hot topics in terms of advancing our knowledge of improving stroke management were highlighted in two presentations which showed the results of two very important trials， the CREST and ACES trial. The findings of these two trials which were published simultaneously in the New England Journal of Medicine and the Lancet respectively are major steps forward in our treatment of carotid disease. The CREST trial added to the current knowledge on how to treat patients with carotid disease. Whether we should use endarterectomy or interventional treatments has been debated for over a decade and the conclusion of all those preceding trials and the latest CREST trial is that firstly carotid endarterectomy is still the gold standard for treatment. Secondly， for patients younger than 60 interventional treatment seems to have an equal effect so there are optional avenues in these patients， but for elderly patients，in particular over 60，， carotid endarterectomy is the first choice of Treatment. There is one question open now for the future which gives us an idea about perspective is that whether the best medical treatment is as good as interventional or surgical treatments. This question has not been answered by any of these trials and in Europe we have just started a phase 2 trial which began last year. This is a three arm trial between best medical treatment， interventional treatment and carotid endarterectomy in asymptomatic patients， and this will give us an answer about the need to do additional treatment by surgery or by intervention. However， the results are not expected to be available for at least 6 or 7 years， we still have a very long way to go. The other highlight were the findings of the ACES trial which aimed to look at the identification of patients with asymptomatic carotid disease without stroke or TIA (Transient Ischemic Attack) and the question if they should be treated and by which way to treat? The authors of this study used ultrasound to identify small micro embolic events in the middle cerebral artery as a potential predictor of the activity of the carotid blood in stenosis. It turned out that this was a very good predictor of a higher risk of stroke development. If you have a hundred patients with asymptomatic carotid disease and you find these doppler signals in 5 of them， the rest of the 95 have a very low risk of suffering a stroke or a TIA. they should definitely not be operated or undergo interventional treated. The only ones who may probably benefit from these additional treatments are the 5% with those signals and this is another good example to individualize treatment for patients at risk of developing stroke.

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