The diagnosis, treatment and follow-up of extracranial carotid stenosis

• Verfasst von: Eckstein, Hans-Henning [VerfasserIn]
• Verfasst von: Kühnl, Andreas [VerfasserIn]
• Verfasst von: Dörfler, Arnd [VerfasserIn]
• Verfasst von: Kopp, Ina B. [VerfasserIn]
• Verfasst von: Lawall, Holger [VerfasserIn]
• Verfasst von: Ringleb, Peter A. [VerfasserIn]
• Titel: The diagnosis, treatment and follow-up of extracranial carotid stenosis
• Titelzusatz: a multidisciplinary German-Austrian guideline based on evidence and consensus
• Verf.angabe: Hans-Henning Eckstein, Andreas Kühnl, Arnd Dörfler, Ina B. Kopp, Holger Lawall, Peter A. Ringleb
• E-Jahr: 2013
• Jahr: July 8, 2013
• Umfang: 9 S.
• Fussnoten: Gesehen am 08.01.2021
• Titel Quelle: Enthalten in: Deutsches Ärzteblatt international
• Ort Quelle: Köln : Dt. Ärzte-Verl., 2006
• Jahr Quelle: 2013
• Band/Heft Quelle: 110(2013), 27-28, Seite 468-476
• ISSN Quelle: 1866-0452
• DOI: doi:10.3238/arztebl.2013.0468
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Austria
• Sach-SW: Cardiology
• Sach-SW: Carotid Stenosis
• Sach-SW: Evidence-Based Medicine
• Sach-SW: Germany
• Sach-SW: Humans
• Sach-SW: Practice Guidelines as Topic
• Sach-SW: Prevalence
• Sach-SW: Survival Analysis
• Sach-SW: Survival Rate
• Sach-SW: Treatment Outcome
• Sach-SW: Vascular Surgical Procedures
• K10plus-PPN: 1744244936

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. - CONCLUSION: Further studies are needed so that better selection criteria can be developed for individually tailored treatment.