Surgical options for primary and secondary prevention of stroke

Summary

Surgical desobliteration of the internal carotid artery is a highly effective option for primary or secondary prophylaxis of stroke in patients with significant symptomatic or asymptomatic carotid artery stenosis (evidence-level 1a). To avoid early recurrence of neurological symptoms in symptomatic patients operation should be performed within two weeks after the initial neurological event. Despite early operation risk of carotid surgery remains low in experienced centres. Adherence to the time frame can be improved by structured interdisciplinary teamwork in a stroke center and may serve as a quality marker. Center specific complications rates have to be taken into account and should be below 3% in asymptomatic patients and 6% in symptomatic patients for combined stroke/death. Benefit of the eversion technique is the reduced re-stenosis rate, whereas endarterectomy offers the benefit of easy use of a shunt. Quality control of the surgical work forms part of the surgical concept.

Keywords

Stroke - carotid artery stenosis - TEA/EEA

• Literatur

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