Download PDF
Dtsch Med Wochenschr 2000; 125(49): 1505-1510
DOI: 10.1055/s-2000-9107
Aktuelle Diagnostik und Therapie
© Georg Thieme Verlag Stuttgart · New York

Aktuelles zur Therapie der Karotisstenose

G. F. Hamann1 , H. Ch Diener2
  • 1Neurologische Klinik des Klinikums Großhadern (Direktor Prof. Dr. Dr. h. c. Th. Brandt, FRCP), Ludwig-Maximillians-Universität München
  • 2Neurologische Klinik (Direktor Prof. Dr. H. Ch. Diener) der Universitätsklinik Essen
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Also available at
    Permissions and Reprints

Nachdem im Jahr 1998 in zwei Artikeln zur Karotisstenose in der »Deutschen Medizinischen Wochenschrift« der damalige Standpunkt der Diagnostik und Therapie aufgezeigt wurde [25] [26], erscheint es nach der Veröffentlichung wichtiger neuerer Ergebnisse an der Zeit, eine aktuelle Ergänzung zu liefern. Der wesentliche Erkenntnisgewinn stammt aus den Auswertungen der beiden großen Studien zur Operation symptomatischer Karotisstenosen (KST) (NASCET-Studie: North American S ymptomatic Carotid E ndarterectomy Trial [1] , ECST-Studie: European C arotid Surgery Trial [2]), sowie aus den neueren Publikationen zur stentgestützten Dilatation als alternativem Behandlungsverfahren. Aufgrund der positiven Studienergebnisse hat die Zahl der Karotisoperationen deutlich zugenommen. Gleichzeitig sind die Komplikationsraten in vielen Zentren den in den großen Multizenterstudien erreichten Zahlen nähergekommen [12] [13] . Die Situation der operativen Versorgung der Karotisstenosen ist damit derzeit günstiger als noch vor Jahren.

Literatur

  • 1 North American Symptomatic Carotid Endarterectomy Trial Collaborators . Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.  N Engl J Med. 1991;  325 445-453
    Google Scholar
  • 2 European Carotid Surgery Trialists Collaborative Group . MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70 - 99 %) or with mild (0 - 29 %) carotid stenosis.  Lancet. 1991;  337 1235-1243
    Google Scholar
  • 3 European Carotid Surgery Trialists Collaborative Group . Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).  Lancet. 1998;  351 1379-1387
    Google Scholar
  • 4 The SYMPHONY Investigators . Comparison of sibrafiban with aspirin for prevention of cardiovascular events after acute coronary syndromes: a randomised trial.. Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes.  Lancet. 2000;  355 337-345
    Google Scholar
  • 5 Al Mubarak N, Roubin G S, Gomez C R. et al . Carotid artery stenting in patients with high neurologic risks.  Am J Cardiol. 1999;  83 1411-1419
    Google Scholar
  • 6 Al Mubarak N, Roubin G S, Liu M W. et al . Early results of percutaneous intervention for severe coexisting carotid and coronary artery disease.  Am J Cardiol. 1999;  84 600-602
    Google Scholar
  • 7 Allenberg J, Brandt T, Thron A. Perkutane transluminale Angioplastie (PTA) und Stenting bei Stenosen der A. carotis interna.  Nervenarzt. 1999;  70 314
    Google Scholar
  • 8 Barnett H J, Taylor D W, Eliasziw M. et al . Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med. 1998;  339 1415-1425
    Google Scholar
  • 9 Benavente O, Moher D, Pham B. Carotid endarterectomy for asymptomatic carotid stenosis: A meta- analysis.  BMJ. 1998;  317 1477-1480
    Google Scholar
  • 10 Bennett C L, Weinberg P D, Rozenberg-Ben-Dror K, Yarnold P R, Kwaan H C, Green D. Thrombotic thrombocytopenic purpura associated with ticlopidine. A review of 60 cases.  Ann Intern Med. 1998;  128 541-544
    Google Scholar
  • 11 Bergeron P, Becquemin J P, Jausseran J M. et al . Percutaneous stenting of the internal carotid artery: The European CAST I Study. Carotid Artery Stent Trial.  J Endovasc Surg. 1999;  6 155-159
    Google Scholar
  • 12 Biller J, Feinberg W M, Castaldo J E. et al . Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association.  Circulation. 1998;  97 501-509
    Google Scholar
  • 13 Brittenden J, Murie J A, Jenkins A M, Ruckley C V, Bradbury A W. Carotid endarterectomy before and after publication of randomized controlled trials.  Br J Surg. 1999;  86 206-210
    Google Scholar
  • 14 Cao P, Giordano G, De Rango P. et al . Eversion versus conventional carotid endarterectomy: Late results of a prospective multicenter randomized trial.  J Vasc Surg. 2000;  31 19-30
    Google Scholar
  • 15 Carlsson J, Miketic S, Batge R, Riedel P, Rahlf G, Tebbe U. Ticlopidine-associated thrombotic thrombocytopenic purpura (Morbus Moschcowitz).  Med Klin. 2000;  95 44-48
    Google Scholar
  • 16 Castaldo J E. Is carotid endarterectomy appropriate for asymptomatic stenosis? Yes.  Arch Neurol. 1999;  56 877-879
    Google Scholar
  • 17 Chambers B R, You R X, Donnan G A. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev CD001923 2000
    Google Scholar
  • 18 Chaturvedi S. Is carotid endarterectomy appropriate for asymptomatic stenosis? No.  Arch Neurol. 1999;  56 879-881
    Google Scholar
  • 19 Eckstein H H, Schumacher H, Klemm K. et al . Emergency carotid endarterectomy.  Cerebrovasc Dis. 1999;  9 270-281
    Google Scholar
  • 20 Ferguson G G, Eliasziw M, Barr H W. et al . The North American Symptomatic Carotid Endarterectomy Trial: Surgical results in 1415 patients.  Stroke. 1999;  30 1751-1758
    Google Scholar
  • 21 Giordano J M. The timing of carotid endarterectomy after acute stroke.  Semin Vasc Surg. 1998;  11 19-23
    Google Scholar
  • 22 Gorelick P B. Carotid endarterectomy: Where do we draw the line?.  Stroke. 1999;  30 1745-1750
    Google Scholar
  • 23 Gorelick P B, Sacco R L, Smith D B. et al . Prevention of a first stroke: A review of guidelines and a multidisciplinary consensus statement from the National Stroke Association.  JAMA. 1999;  281 1112-1120
    Google Scholar
  • 24 Gross C M, Kramer J, Uhlich F. et al . Treatment of carotid artery stenosis by elective stent placement instead of carotid endarterectomy in patients with severe coronary artery disease.  Thromb Haemost. 1999;  82 (Suppl 1) 176-180
    Google Scholar
  • 25 Hamann G F. Diagnostik der extrakraniellen Karotisstenose.  Dtsch Med Wochenschr. 1998;  123 1075-1080
    Google Scholar
  • 26 Hamann G F. Therapie der extrakraniellen Karotisstenose.  Dtsch Med Wochenschr. 1998;  123 1109-1115
    Google Scholar
  • 27 Hankey G J. Stroke: How large a public health problem, and how can the neurologist help?.  Arch Neurol. 1999;  56 748-754
    Google Scholar
  • 28 Hobson R W, Brott T, Ferguson R. et al . CREST: Carotid revascularization endarterectomy versus stent trial.  Cardiovasc Surg. 1997;  5 457-458
    Google Scholar
  • 29 Hoffmann M, Robbs J. Carotid endarterectomy after recent cerebral infarction.  Eur J Vasc Endovasc Surg. 1999;  18 6-10
    Google Scholar
  • 30 Inzitari D, Eliasziw M, Gates P. et al . The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis.  N Engl J Med. 2000;  342 1693-1700
    Google Scholar
  • 31 Kahn M B, Patterson H K, Seltzer J. et al . Early carotid endarterectomy in selected stroke patients.  Ann Vasc Surg. 1999;  13 463-467
    Google Scholar
  • 32 Kappelle L J, Eliasziw M, Fox A J, Sharpe B L, Barnett H J. Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. The North American Symptomatic Carotid Endarterectomy Trail.  Stroke. 1999;  30 282-286
    Google Scholar
  • 33 Kistler J P, Furie K L. Carotid endarterectomy revisited.  N Engl J Med. 2000;  342 1743-1745
    Google Scholar
  • 34 Lanzino G, Mericle R A, Lopes D K, Wakhloo A K, Guterman L R, Hopkins L N. Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis.  J Neurosurg. 1999;  90 688-694
    Google Scholar
  • 35 Leisch F, Kerschner K, Hofman R, Bibl D, Engleder C, Bergmann H. Carotid stenting: acute results and complications.  Z Kardiol. 1999;  88 661-668
    Google Scholar
  • 36 Liu A Y, Paulsen R D, Marcellus M L, Steinberg G K, Marks M P. Long-term outcomes after carotid stent placement treatment of carotid artery dissection.  Neurosurgery. 1999;  45 1368-1373
    Google Scholar
  • 37 Mathias K, Jäger H, Sahl H, Hennings S, Gißler H -M. Die endoluminale Therapie der Kaotisstenose.  Dt Ärztebl. 1999;  96 A-2502-A-2508
    Google Scholar
  • 38 Ohki T, Roubin G S, Veith F J, Iyer S S, Brady E. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: An ex vivo analysis.  J Vasc Surg. 1999;  30 1034-1044
    Google Scholar
  • 39 Paciaroni M, Eliasziw M, Kappelle L J, Finan J W, Ferguson G G, Barnett H J. Medical complications associated with carotid endarterectomy. North American Symptomatic Carotid Endarterectomy Trial (NASCET).  Stroke. 1999;  30 1759-1763
    Google Scholar
  • 40 Papavasiliou A K, Magnadottir H B, Gonda T, Franz D, Harbaugh R E. Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics.  J Neurosurg. 2000;  92 291-296
    Google Scholar
  • 41 Patel S T, Haser P B, Korn P, Bush H L Jr, Deitch J S, Kent K C. Is carotid endarterectomy cost-effective in symptomatic patients with moderate (50 % to 69 %) stenosis?.  J Vasc Surg. 1999;  30 1024-1033
    Google Scholar
  • 42 Qureshi A I, Luft A R, Janardhan V. et al . Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting.  Stroke. 2000;  31 376-382
    Google Scholar
  • 43 Ricco J B, Illuminati G, Bouin-Pineau M H. et al . Early carotid endarterectomy after a nondisabling stroke: a prospective study.  Ann Vasc Surg. 2000;  14 89-94
    Google Scholar
  • 44 Rothwell P M. Carotid endarterectomy for recently symptomatic carotid stenosis: consistent results from two large randomized controlled trials.  Eur Heart J. 1999;  20 1055-1057
    Google Scholar
  • 45 Rothwell P M, Warlow C P. European Carotid Surgery Trialists Collaborative Group . Interpretation of operative risks of individual surgeons.  Lancet. 1999;  353 1325
    Google Scholar
  • 46 Rothwell P M, Warlow C P. European Carotid Surgery Trialists Collaborative Group . Prediction of benefit from carotid endarterectomy in individual patients: A risk-modelling study.  Lancet. 1999;  353 2105-2110
    Google Scholar
  • 47 Roubin G S. The status of carotid stenting.  Am J Neuroradiol. 1999;  20 1378-1381
    Google Scholar
  • 48 Schneider C, Johansen K, Konigstein R, Metzner C, Oettinger W. Emergency carotid thromboendarterectomy: Safe and effective.  World J Surg. 1999;  23 1163-1167
    Google Scholar
  • 49 Sievert H, Pfeil W, Bosenberg I, Spies H, Theis R, Beykirch K F. Primäre Stentversorgung der Arteria carotis interna.  Dtsch Med Wochenschr. 1999;  124 1262-1266
    Google Scholar
  • 50 Taylor D W, Barnett H J, Haynes R B. et al . Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: A randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators.  Lancet. 1999;  353 2179-2184
    Google Scholar
  • 51 Warlow C. Carotid endarterectomy for asymptomatic carotid stenosis. Better data, but the case is still not convincing.  BMJ. 1998;  317 1468
    Google Scholar
  • 52 Wholey M H, Wholey M, Bergeron P. et al . Current global status of carotid artery stent placement.  Cathet Cardiovasc Diagn. 1998;  44 1-6
    Google Scholar

Korrespondenz

Prof. Dr. Gerhard F. Hamann

Stroke-unit Neurologische Klinik Klinikum Großhadern Ludwig-Maximillians-Universität München

81366 München

Phone: 089/7095-3670

Fax: 089/7095-3677

Email: hamann@brain.nefo.med.uni-muenchen.de

      >