[Postoperative results of treatment in comparison with results of the German prospective randomized CASANOVA Study]

Independent of the results pending from the postoperative randomized German multicenter trial (CASANOVA Study), in which the course of operative versus non-operative treatment of asymptomatic carotid artery stenoses is being compared, there is still a clear justification for operative desobliteration if the following criteria are fulfilled: 1. Severe carotid stenosis with hemodynamic significance is proved by an extremely reduced or abolished autoregulatory reserve in the transcranial Doppler CO2-test. 2. Lesions with high embolic risk are confirmed by arteriography or B-Scan sonography. In 744 patients who underwent surgery according to these prerequisites there was a mere annual stroke rate of 0.2% during a followup of up to 18 years. This means that in comparison with the results of non-surgical therapy (annual stroke rate 1-3%) the risk of stroke was reduced by tenfold.