[When is interventional therapy necessary for carotid stenosis?].
Stenoses of the internal carotid artery are common. 20-30% of ischaemic cerebrovascular events are due to atherosclerotic lesions of carotid arteries. For many years endarterectomy has been a method for prevention of cerebral ischaemia. There is confusion about how carotid stenosis should be measured on angiograms. Since the results of clinical trials based on different measurement methods are applied to routine clinical practice, the various measurement methods must be comparable. We must know which one was used, and how to convert them by a simple arithmetical equation. Carotid endarterectomy appears to be highly beneficial in patients with recent hemispheric transient ischaemic attacks or non-disabling stroke and ipsilateral high-grade stenosis (> or = 60-70%) of the internal carotid artery. Even asymptomatic patients with high-grade stenosis benefit to some extent from surgery, and the beneficial effects correlate directly with the degree of stenosis. Endarterectomy in moderate symptomatic stenosis (50-69%) yields only a moderate reduction in stroke risk. In stenosis < 50% there is no benefit. Decisions about endarterectomy should take into account the natural history of stroke in carotid stenosis, surgical skills, and the individual patient's risk factors.
Canova
C R
CR
Medizinische Klinik, Kantonsspital Chur. cornia.canova@ksc.gr.ch
D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006801:Humans; D020521:Stroke / Q000209:etiology / Q000517:prevention & control