Positionspapier zur Indikation und Durchführung der interventionellen Behandlung extrakranieller Karotisstenosen

Abstract

Interventional treatment of extracranial carotid stenoses: current status, requirements and indications Around 30000 strokes per year in Germany are caused by extracranial obstructions of the carotid arteries. Besides the well established surgical endatherectomy, which has been proven to be superior to medical treatment alone in randomized multicenter trials, percutaneous treatment by balloon angioplasty and stent placement is increasingly performed. This consensus paper summarizes the present status of scientific studies and controlled treatment registries of carotid angioplasty and stenting and yields to recommendations regarding its performance and indication. A Medline search was done until August 2005 including all randomized comparative studies with clinical endpoints and all controlled registries with more than 500 patients included. Both completed randomized trials comparing angioplasty and stenting with surgery (CAVATAS and SAPPHIRE) did not show a significant difference with respect to stroke and death within 30 days. The incidence of this combined endpoint was between 3.3 and 6.9% in large multicenter registries. Thus, the current endovascular treatment results in a perlinterventional complication rate comparable to that which is commonly accepted for vascular surgery. A systematic preferably external quality monitoring as well as interdisciplinary cooperation most importantly with neurologists is recomendedfor all interventionalists. Based on available clinical data, this consensus paper defines recommendation classes I or II with a level of evidence B or C depending on symptoms, operative risk status of the patient and severity of the underlying stenosis.