Behandlung der Karotisstenose durch Stentimplantation

The incidence of arterioarterial stroke originating from the supra-aortic branches is 187/100,000/year.The 90-day prognosis shows a probability of 15% mortality and 19% severe disability. Based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST), the indications for endarterectomy have a high level of evidence. Recommendations for carotid endarterectomy depending on the perioperative risk are defined in the American Heart Association (AHA) and European Stroke Initiative (EUSI) proposals. Several trials have shown that stent supported carotid angioplasty is now an almost equivalent alternative for short-term and intermediate-term follow-up, and an even safer alternative technique in surgically high risk patients. However, the following contraindications must be taken into consideration: thrombosis of the internal carotid artery, long stenoses, aneurysms of the aortic arch with involvement of the supra-aortic branches, carotid occlusion in cases of maintenance of the branchial artery coiling of the internal exit area, as well as severe contrast medium allergy. For the endovascular surgeon this implies the need to learn about and to be involved in using this challenging technique. This therapeutic option allows patient oriented therapy and may further reduce the overall complication rate of carotid stenosis therapy.