[The indications and embolism monitoring in lumen-opening therapies of the a. carotis].
Carotid endarterectomy (CEA) is proven to be beneficial in symptomatic patients with high-grade carotid stenosis (70% to 99%; residual lumen as a percentage of the normal distal internal carotid artery) on condition that the peri-operative risk for mortality and morbidity is less than 6%. A minority of the "leading experts" in North America (48%) and Western Europe (28%) recommends carotid endarterectomy in asymptomatic patients in general. Most experts suggest to perform surgery only in asymptomatic patients who are at risk for carotid occlusion in the near future or embolism. At its present state, angioplasty and stenting is an experimental although promising technique which will have to be compared to carotid endarterectomy. Criteria for duplex grading of internal carotid stenosis have been established and systematically validated to results of angiography. Pre-surgical use of angiography will more and more be restricted to selected patients in whom the results of duplex sonography remain inconclusive. The detection of microemboli with transcranial doppler sonography seems to be of particular importance before and during carotid angioplasty and stenting.
Lang
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W
Abteilung für Klinische Neurologie, Universitätskliniken Wien. wilfried.lang@univie.ac.at
Willfort
A
A
Nasel
C
C
Lalouschek
W
W
D000800:Angioplasty, Balloon; D002341:Carotid Artery Thrombosis / Q000175:diagnosis*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006439:Hemodynamics; D006801:Humans; D008991:Monitoring, Physiologic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015607:Stents