title: The diagnosis, treatment and follow-up of extracranial carotid stenosis.
abstract: BACKGROUND
  Extracranial atherosclerotic lesions of the carotid bifurcation cause 10% to 20% of all cases of cerebral ischemia. Until now, there have been no comprehensive evidence- and consensus-based recommendations for the management of patients with extracranial carotid stenosis in Germany and Austria.
  
  
  METHODS
  The literature was systematically searched for pertinent publications (1990-2011). On the basis of 182 randomized clinical trials (RCTs) and 308 systematic reviews, 30 key questions were answered and evidence-based recommendations were issued.
  
  
  RESULTS
  The prevalence of extracranial carotid stenosis is more than 5% from age 65 onward. Men are affected twice as frequently as women. The most important diagnostic technique is Doppler- and color-coded duplex ultrasonography. RCTs have shown that the treatment of high-grade asymptomatic carotid stenosis with carotid endarterectomy (CEA) can lower the 5-year risk of stroke from 11% to 5%. Intensive conservative treatment may lower the stroke risk still further. Moreover, RCTs have shown that CEA for symptomatic 50% to 99% carotid stenosis lowers the 5-year stroke risk by 5% to 16%. Meta-analyses of the 13 available RCTs comparing carotid artery stenting (CAS) with CEA have shown that CAS is associated with a 2% to 2.5% higher risk of periprocedural stroke or death and with a 0.5% to 1% lower risk of periprocedural myocardial infarction. If no particular surgical risk factors are present, CEA is the standard treatment for high-grade carotid stenosis. CAS may be considered as an alternative to CEA if the rate of procedure-related stroke or death can be kept below 3% or 6% for asymptomatic and symptomatic stenosis, respectively.
  
  
  CONCLUSIONS
  Further studies are needed so that better selection criteria can be developed for individually tailored treatment.
authors: Department of Vascular and Endovascular Surgery/Vascular Center, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany. HHEckstein@web.de
authors: Hans-Henning
authors: HH
authors: Eckstein
authors: Andreas
authors: A
authors: Kühnl
authors: Arnd
authors: A
authors: Dörfler
authors: Ina B
authors: IB
authors: Kopp
authors: Holger
authors: H
authors: Lawall
authors: Peter A
authors: PA
authors: Ringleb
mesh_terms: D001317:Austria / Q000453:epidemiology; D002309:Cardiology / Q000592:standards*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D019317:Evidence-Based Medicine; D005858:Germany / Q000453:epidemiology; D006801:Humans; D017410:Practice Guidelines as Topic; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality
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