Die Karotisstenose im Fokus klinischer Studien – Chirurgie, Angioplastie oder medikamentöse Therapie?

Der Nutzen der Karotischirurgie, verglichen mit der alleinigen medikamentösen Therapie von Patienten mit symptomatischen und asymptomatischen Karotisstenosen konnte zu Beginn der 90er Jahre durch verschiedene randomisierte Studien (NASCET, ECST, ACAS, ACST) nachgewiesen werden. Die Karotisangioplastie ist eines der innovativsten Felder auf dem Gebiet endovaskulärer Interventionen und wird mittlerweile bereits in vielen Zentren weltweit routinemäßig durchgeführt. Trotz ähnlicher Ergebnisse im Vergleich beider Interventionen (z. B. CAVATAS, SPACE) ist die Angioplastie noch nicht als gleichwertige Alternative zur Chirurgie anerkannt. Jedoch wird durch zunehmende Erfahrungen der Interventionalisten, durch die Entwicklung neuer Stents, Filter und Embolieprotektionen und durch die kürzlich abgeschlossene CREST–Studie sowie noch laufende Studien (TACIT, ICSS, ACT 1) erwartet, endgültig die Äquivalenz oder sogar Überlegenheit der stentgestützten Karotisangioplastie im Vergleich zur Chirurgie aufzeigen zu können.

The benefit of carotid surgery compared to medical treatment in patients who suffer from symptomatic carotid stenosis as well as from asymptomatic ones has been shown in the early 1990s by several randomized trials (NASCET, ECST, ACAS, ACST). Carotid stenting is one of the most dynamic and innovative fields in the area of vascular interventions and is now performed routinely in many centers worldwide. Nevertheless, despite similar trial results comparing both interventions (CAVATAS, SPACE), there is still no general agreement whether stenting should be accepted as an alternative method to surgery or not. But due to the interventionalists' gaining expertise and experience as well as the design of new stents, filters and embolic protection devices with already completed trials (CREST) as well as ongoing trials (TACIT, ICSS, ACT 1) may to prove equivalence or even superiority of carotid artery stenting compared to surgery.

Key words

Carotid artery disease - carotid stent - stroke - endarterectomy - angioplasty - prevention

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