Nervenheilkunde 2011; 30(04): 254-258
DOI: 10.1055/s-0038-1627800
Fortbildung Kaiserslautern
Schattauer GmbH

Surgical options for primary and secondary prevention of stroke

Article in several languages: deutsch | English
M. Dahm
1   Thorax-, Herz- und Gefäßchirurgische Klinik, Westpfalz-Klinikum Kaiserslautern
› Author Affiliations
Further Information

Publication History

Eingegangen am: 04 October 2010

angenommen am: 10 October 2010

Publication Date:
23 January 2018 (online)


Surgical desobliteration of the internal carotid artery is a highly effective option for primary or secondary prophylaxis of stroke in patients with significant symptomatic or asymptomatic carotid artery stenosis (evidence-level 1a). To avoid early recurrence of neurological symptoms in symptomatic patients operation should be performed within two weeks after the initial neurological event. Despite early operation risk of carotid surgery remains low in experienced centres. Adherence to the time frame can be improved by structured interdisciplinary teamwork in a stroke center and may serve as a quality marker. Center specific complications rates have to be taken into account and should be below 3% in asymptomatic patients and 6% in symptomatic patients for combined stroke/death. Benefit of the eversion technique is the reduced re-stenosis rate, whereas endarterectomy offers the benefit of easy use of a shunt. Quality control of the surgical work forms part of the surgical concept.

  • Literatur

  • 1 AbuRahma AF, Robinson PA, Saiedy S, Kahn JH, Boland JP. Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: long-term follow-up. J Vasc Surg 1998; 27 (02) 222-32.
  • 2 AbuRahma AF, Robinson PA, Saiedy S, Richmond BK, Khan J. Prospective randomized trial of bilateral carotid endarterectomies: primary closure versus patching. Stroke 1999; 30 (06) 1185-9.
  • 3 Anzidei M, Napoli A, Geiger D, Cavallo BMarincola, Zini C, Zaccagna F, Di Paolo P, Catalano C, Passariello R. preliminary experience with MRA in evaluating the degree of carotid stenosis and plaque morphology using high-resolution sequences after gadofosveset trisodium (Vasovist) administration: comparison with CTA and DSA. Radiol Med 2010; 115 (04) 634-7.
  • 4 Aleksic M. Immediate CEA for symptomatic carotid disease preferably per-formed under local anaesthesia is safe. Vasa 2007; 36 (03) 185-90.
  • 5 Aleksic M, Luebke T, Brunkwall J. Outcome of carotid endarterectomy under local anaesthesia with respect to the patients’ risk profile. Vasa 2009; 38 (03) 225-33.
  • 6 Ballotta E, Meneghetti G, DaGiau G, Manara R, Saladini M, Baracchini C. Carotid endarterectomy within 2 weeks of minor ischemic stroke: a prospective study. J Vasc Surg 2008; 48: 595-600.
  • 7 Ballotta E, Renon L, Da Giau G, Toniato A, Baracchini C, Abbruzzese E, Saladini M, Moscardo P. A prospective randomized study on bilateral carotid endarterectomy: patching versus eversion. Ann Surg 2000; 232 (01) 119-25.
  • 8 Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339 (20) 1415-25.
  • 9 Bartoli MA, Squarcioni C, Nicoli F, Magnan PE, Malikov S, Berger L, Lerussi GB, Branchereau A. Early carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke. Eur J Vasc Endovasc Surg 2009; 37 (05) 512-8.
  • 10 Cao P, Giordano G, De Rango P, Zannetti S, Chiesa R, Coppi G, Palombo D, Peinetti F, Spartera C, Stancanelli V, Vecchiati E. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg 2000; 31 (1 Pt 1): 19-30.
  • 11 Eckstein HH, Heider P, Wolf O, Barone M, Hanke M. Controversies in the treatment of carotid stenoses. Present state of research and evidence-based medicine. Chirurg 2004; 75 (07) 672-80.
  • 12 European Carotid Surgery Trialists Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351 (9113): 1379-87.
  • 13 Gladstone DJ, Oh J, Fang J, Lindsay P, Tu JV, Silver FL, Kapral MK. Urgency of carotid endarterectomy for secondary stroke prevention. Stroke 2009; 40: 2776-82.
  • 14 Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D. MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363 (9420): 1491-502.
  • 15 Leitlinien der Deutschen Gesellschaft für Neurologie und der Deutschen Schlaganfall Gesellschaft: Primärund Sekundärprophylaxe des Schlaganfalls. Berlin.:
  • 16 Kolominsky-Rabas PL, Heuschmann PU. Incidence, etiology and long-term prognosis of stroke. Fortschritte der Neurologie Psychiatrie 2002; 70: 657-62.
  • 17 Matsumoto S, Nakahara I, Higashi T, Iwamuro Y, Watanabe Y, Takahashi K, Ando M, Takezawa M, Kira JI. Near-infrared spectroscopy in carotid artery stenting predicts cerebral hyperperfusion syndrome. Neurology 2009; 72 (17) 1512-8.
  • 18 Parrino PE, Lovelock M, Shockey KS, King C, Tribble CG, Kron IL. Early carotid endarterectomy after stroke. Cardiovasc Surg 2000; 08 (02) 116-20.
  • 19 Picton P, Chambers J, Shanks A, Dorje P. The influence of inspired oxygen fraction and end-tidal carbon dioxide on post-cross-clamp cerebral oxygenation during carotid endarterectomy under general anesthesia. Anesth Analg 2010; 110 (02) 581-7.
  • 20 Schneider JR, Droste JS, Schindler N, Golan JF, Bernstein LP. RS Rosenberg. Carotid endarterectomy with routine electroencephalography and selective shunting: Influence of contralateral internal carotid artery occlusion and utility in prevention of perioperative strokes. J Vasc Surg 2002; 35 (06) 1114-21.
  • 21 Rantner B. American Society of anesthesiology and rankin as predictive parameters for the outcome of carotid endarterectomy within 28 days after an ischemic stroke. J Stroke Cerebrovasc Dis 2006; 15 (03) 114-20.
  • 22 Rerkasem K, Rothwell PM. Local versus general anaesthesia for carotid endarterectomy. Rerkasem Cochrane Database Rev. 2008 (4):CD000126..
  • 23 Rerkasem K, Rothwell PM. Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery. Stroke 2009; 40 (10) e564-72.
  • 24 Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363: 915-24.
  • 25 Slovut DP, Romero JM, Hannon KM, Dick J, Jaff MR. Detection of common carotid artery stenosis using duplex ultrasonography: a validation study with computed tomographic angiography. J Vasc Surg 2010; 51 (01) 65-70.
  • 26 Ward A, Payne KA, Caro JJ, Heuschmann PU, Kolominsky-Rabas PL. Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project. European Journal of Neurology 2005; 12 (04) 264-7.