Aktuelle Studienlage zu Karotisangioplastie und -stenting

Zusammenfassung

Die Prävalenz extrakranieller Stenosen der Arteria carotis interna (ACI) beträgt in der 6. Lebensdekade 0,5 %, steigt um das 80. Lebensjahr jedoch auf etwa 10 % an. Karotisstenosen sind die Ursache von etwa 10 % aller ischämischen Hirninfarkte und von etwa 15 % aller transitorischen ischämischen Attacken (TIA). Das Rezidivrisiko für eine erneute zerebrale Ischämie aufgrund einer unbehandelten Karotisstenose beträgt innerhalb der ersten 3 Monate nahezu 20 %. Die Behandlung der Karotisstenose nimmt daher in der Schlaganfallprävention eine herausragende Rolle ein. Dieser Artikel widmet sich schwerpunktmäßig der gegenwärtigen Studienlage zur perkutanen Karotisangioplastie mit Stentimplantation im Vergleich zur Karotisthrombendarterektomie. Zusammenfassend stellen wir den gegenwärtigen Standpunkt des Calgary Stroke Programs der University of Calgary und des Dresdner Universitäts Schlaganfall Centrums als Beispiele für ein nordamerikanisches und ein deutsches Schlaganfallzentrum zum konkreten Vorgehen bei Patienten mit extrakraniellen Karotisstenosen dar.

Abstract

Population-based studies indicate that the prevalence of carotid stenosis is 0.5 % in the sixth decade of life but increases up to 10 % by the age of 80 years. Ipsilateral carotid stenosis, with > 50 % of the artery occluded, is found in about 10 % of carotid territory ischemic strokes and in about 15 % of transient ischemic attacks (TIA), and is associated with a high-risk of recurrent stroke. Treatment of carotid artery disease plays a major role in stroke prevention. In this article we focus on the role of carotid artery angioplasty and stenting as compared with carotid endarterectomy. We summarize the current positions of the Calgary Stroke Program and the Dresden University Stroke Centre in the treatment of patients with extracranial carotid stenosis as examples for a North American and a German Stroke Centre.

Schlüsselwörter

Stenting - Endarterektomie - Karotis - Stenose

Key words

stenting - endarterectomy - carotid artery - stenosis

Literatur

• 1 O'Leary D H, Polak J F, Kronmal R A. et al . Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group.  Stroke. 1992;  23 1752-1760
• 2 Lovett J K, Coull A J, Rothwell P M. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies.  Neurology. 2004;  62 569-573
• 3 Kennedy J, Quan H, Buchan A M. et al . Statins are associated with better outcomes after carotid endarterectomy in symptomatic patients.  Stroke. 2005;  36 2072-2076
• 4 Mathias K. [A new catheter system for percutaneous transluminal angioplasty (PTA) of carotid artery stenoses].  Fortschr Med. 1977;  95 1007-1011
• 5 Mathias K, Mittermayer C, Ensinger H, Neff W. [Percutaneous catheter dilatation of carotid stenoses – animal experiments (author's transl)].  Rofo. 1980;  133 258-261
• 6 Theron J, Raymond J, Casasco A, Courtheoux F. Percutaneous angioplasty of atherosclerotic and postsurgical stenosis of carotid arteries.  AJNR Am J Neuroradiol. 1987;  8 495-500
• 7 Kachel R. Results of balloon angioplasty in the carotid arteries.  J Endovasc Surg. 1996;  3 22-30
• 8 Serruys P W, van Hout B, Bonnier H. et al . Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II).  Lancet. 1998;  352 673-681
• 9 DeBakey M E. Carotid endarterectomy revisited.  J Endovasc Surg. 1996;  3 4
• 10 Barnett H J. Clinical trials in stroke prevention.  Arzneimittelforschung. 1991;  41 340-344
• 11 Barnett H J, Plum F, Walton J N. Carotid endarterectomy – an expression of concern.  Stroke. 1984;  15 941-943
• 12 Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med. 1991;  325 445-453
• 13 Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.  JAMA. 1995;  273 1421-1428
• 14 Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).  Lancet. 1998;  351 1379-1387
• 15 Halliday A, Mansfield A, Marro J. et al . Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial.  Lancet. 2004;  363 1491-1502
• 16 Rothwell P M, Eliasziw M, Gutnikov S A. et al . Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis.  Lancet. 2003;  361 107-116
• 17 Rothwell P M, Eliasziw M, Gutnikov S A. et al . Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.  Lancet. 2004;  363 915-924
• 18 Rothwell P M, Eliasziw M, Gutnikov S A. et al . Sex difference in the effect of time from symptoms to surgery on benefit from carotid endarterectomy for transient ischemic attack and nondisabling stroke.  Stroke. 2004;  35 2855-2861
• 19 Chambers B R, Roberts N G. Asymptomatic carotid artery stenosis.  Curr Treat Options Cardiovasc Med. 2007;  9 81-89
• 20 Ederle J, Brown M M. The evidence for medicine versus surgery for carotid stenosis.  Eur J Radiol. 2006;  60 3-7
• 21 Qureshi A I. Endovascular treatment of cerebrovascular diseases and intracranial neoplasms.  Lancet. 2004;  363 804-813
• 22 Wennberg D E, Lucas F L, Birkmeyer J D. et al . Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics.  JAMA. 1998;  279 1278-1281
• 23 Ouriel K, Hertzer N R, Beven E G. et al . Preprocedural risk stratification: identifying an appropriate population for carotid stenting.  J Vasc Surg. 2001;  33 728-732
• 24 Fisher E S, Malenka D J, Solomon N A. et al . Risk of carotid endarterectomy in the elderly.  Am J Public Health. 1989;  79 1617-1620
• 25 Disque C, Alex H, Gahn G, Kummer R von. Stentgeschützte Angioplastie der Arteria carotis interna als Notfallmaßnahme beim akuten Schlaganfall.  Klin Neuroradiol. 2004;  14 134-137
• 26 Coward L J, Featherstone R L, Brown M M. Safety and efficacy of endovascular treatment of carotid artery stenosis compared with carotid endarterectomy: a Cochrane systematic review of the randomized evidence.  Stroke. 2005;  36 905-911
• 27 Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.  Lancet. 2001;  357 1729-1737
• 28 Yadav J S, Wholey M H, Kuntz R E. et al . Protected carotid-artery stenting versus endarterectomy in high-risk patients.  N Engl J Med. 2004;  351 1493-1501
• 29 Halm E A, Hannan E L, Rojas M. et al . Clinical and operative predictors of outcomes of carotid endarterectomy.  J Vasc Surg. 2005;  42 420-428
• 30 Mehta R H, Zahn R, Hochadel M. et al . Comparison of in-hospital outcomes of patients with versus without previous carotid endarterectomy undergoing carotid stenting (from the German ALKK CAS Registry).  Am J Cardiol. 2007;  99 1288-1293
• 31 Ringleb P A, Allenberg J, Bruckmann H. et al . 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial.  Lancet. 2006;  368 1239-1247
• 32 Piaggio G, Elbourne D R, Altman D G. et al . Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement.  JAMA. 2006;  295 1152-1160
• 33 Gotzsche P C. Lessons from and cautions about noninferiority and equivalence randomized trials.  JAMA. 2006;  295 1172-1174
• 34 Naylor A R. SPACE: not the final frontier.  Lancet. 2006;  368 1215-1216
• 35 Roffi M, Yadav J S. Carotid stenting.  Circulation. 2006;  114 e1-4
• 36 Mas J L, Chatellier G, Beyssen B. et al . Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.  N Engl J Med. 2006;  355 1660-1671
• 37 Mas J L, Chatellier G, Beyssen B. Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) trial.  Stroke. 2004;  35 e18-20
• 38 Furlan A J. Carotid-artery stenting – case open or closed?.  N Engl J Med. 2006;  355 1726-1729
• 39 Hobson 2nd  R W, Howard V J, Roubin G S. et al . Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase.  J Vasc Surg. 2004;  40 1106-1111
• 40 Narins C R, Illig K A. Patient selection for carotid stenting versus endarterectomy: a systematic review.  J Vasc Surg. 2006;  44 661-672
• 41 Eckert B, Zeumer H. Editorial comment – Carotid artery stenting with or without protection devices? Strong opinions, poor evidence!.  Stroke. 2003;  34 1941-1943
• 42 Hill M D, Morrish W, Soulez G. et al . Multicenter evaluation of a self-expanding carotid stent system with distal protection in the treatment of carotid stenosis.  AJNR Am J Neuroradiol. 2006;  27 759-765
• 43 Sacco R L, Adams R, Albers G. et al . Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline.  Circulation. 2006;  113 e409-449
• 44 Barr J D, Connors 3rd  J J, Sacks D. et al . Quality improvement guidelines for the performance of cervical carotid angioplasty and stent placement.  AJNR Am J Neuroradiol. 2003;  24 2020-2034
• 45 Connors 3rd  J J, Sacks D, Furlan A J. et al . Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American Academy of Neurology, American Association of Neurological Surgeons, American Society of Interventional and Therapeutic Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, AANS/CNS Cerebrovascular Section, and Society of Interventional Radiology.  Radiology. 2005;  234 26-34
• 46 Bates E R, Babb J D, Casey Jr D E. et al . ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting).  Journal of the American College of Cardiology. 2007;  49 126-170