[Carotis stenosis-open surgery and endovascular treatment]

Patients who have a carotid stenosis and suffer a TIA have a high risk of stroke shortly afterwards, and should be offered prophylactic surgery within 2 weeks. We present the results for treatment of carotid stenosis from Oslo University Hospital, Rikshospitalet in the period 2001-2008.

The material comprises all patients treated for carotid stenosis, with either carotid thrombendarterectomy (CEA) or endovascular stenting, in the period 2001-2008. All procedures were prospectively recorded in a database. A neurologist examines the patients before, and 1 and 12 months after treatment.

408 carotid stenoses were treated in the observation period. Median age (range) was 68 years (21-85), and 125 (31 %) patients were women. 206 (64.2 %) of the 321 stenoses treated with CEA were symptomatic as were 53 (61 %) of the 87 who underwent endovascular treatment (87). The rate of serious stroke and/or death within 30 days after CEA was 1.9 % for symptomatic stenoses and 1.1 % for asymptomatic stenoses; after endovascular treatment the corresponding numbers were 1.9 % and 3.8 %.

We have offered endovascular treatment to patients in whom surgery would be complicated (restenosis, radiation-induced stenosis etc). Results could therefore not be compared within our material. CEA prevents stroke, and it has been shown that the risk of complications is higher with stenting. Evaluation and treatment of patients with carotid stenosis should be included in the planned National guidelines for stroke treatment.