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[Operative and endovascular treatment of carotis stenosis--when is it indicated?]

Kirsten Krohg-Sørensen1, Søren Jacob Bakke, David Russell

  • 1Karkirurgisk seksjon, Thoraxkirurgisk avdeling, Rikshospitalet-Radiumhospitalet0027 Oslo. kirsten.krohg-sorensen@rikshospitalet.no

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|April 17, 2007
PubMed

Insights

Carotid endarterectomy significantly reduces stroke risk for stenoses over 50%, especially when symptomatic. Early intervention is crucial for preventing disability from carotid artery disease.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Preventive Medicine

Background:

  • Stroke is a leading cause of disability in Norway, with ischemic strokes comprising the majority.
  • A significant portion of ischemic strokes result from emboli originating in atherosclerotic plaques within pre-cerebral arteries.

Purpose of the Study:

  • To review existing literature on the efficacy of surgical and endovascular interventions for stroke prevention in patients with carotid bifurcation stenoses.

Main Methods:

  • Comprehensive literature search of PubMed and Cochrane Library databases.
  • Evaluation supplemented by relevant textbook chapters and expert clinical experience.

Main Results:

  • Carotid endarterectomy is proven effective, reducing 5-year stroke risk by over 50% stenosis with surgery plus best medical treatment versus best medical treatment alone.
  • Symptomatic stenoses, particularly those treated promptly after symptom onset, show the greatest benefit.
  • For asymptomatic patients, surgery lowers the 5-year stroke risk from 11.8% to 6.4%, necessitating careful consideration of patient factors and surgical center quality.

Conclusions:

  • Urgent carotid ultrasound referral is recommended for patients experiencing transient ischemic attack, minor stroke, or amaurosis fugax.
  • Surgical intervention is indicated for >70% stenosis and for men with moderate (50-69%) stenosis; moderate stenosis in women requires individual assessment.
  • Evidence for endovascular treatment efficacy is lacking; patients suitable for stenting should be enrolled in comparative trials against endarterectomy.
Abstract

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