[Interventions in carotid stenoses: carotid srugery, percutaneous transluminal balloon angioplasty and stent implantation. Indications, results of clinical studies. An overview].
Ischemic stroke is the third most reason of death and the main reason of severe disability in Western countries. The high incidence of stroke, 330 per 100,000 subjects in Germany, illustrates the importance of the disease. Generally, atherosclerotic stenosis of the proximal internal carotid artery is the responsible mechanism. The clinical efficiency of surgically performed endarterectomy has been demonstrated in several large multicenter trials. Proven indications for endarterectomy are symptomatic moderate to high-grade stenoses, rapidly progressive asymptomatic stenoses and asymptomatic patients with lesions revealing greater than sixty percent diameter stenosis under certain clinical conditions. Reduction of the incidence of cerebrovascular events, though, is only possible if a low perioperative complication rate is accomplished. Recommendations of the American Heart Association demand a total periprocedural complication rate less than six percent for symptomatic and less than three percent for asymptomatic stenoses. Implantation of stents in carotid arteries is a promising method which might expand the spectrum of indications toward stenosis morphology unfavorable for surgery and patients with significant comorbidity. Clinical results reveal primary success rates, complication rates, and restenosis rates comparable with those of surgical endarterectomy. Randomized trials, comparing both methods, are necessary and reasonable. Yet results are not available at the moment.
Schiele
T M
TM
Medizinische Klinik Innenstadt, Ludwig-Maximilians-Universität, Abteilung für Kardiologie, Ziemssenstr. 1 80336 München.
Niehues
R
R
Knobloch
W
W
Metzger
G
G
Jacksch
R
R
D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000628:therapy*; D002986:Clinical Trials as Topic; D016894:Endarterectomy, Carotid; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D015607:Stents