Lanczik O, Bäzner H, Hennerici M G, Kern R
Neurologische Universitätsklinik Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim.
Nervenarzt. 2006 Sep;77 Suppl 1:S5-12; quiz S13-4. doi: 10.1007/s00115-006-2145-4.
Asymptomatic carotid stenoses are common. They are associated with the risk factors for arteriosclerosis and are a specific risk factor for coronary artery disease, with an annual morbidity/mortality (MM) rate of 8-10%. Detection of a carotid stenosis should therefore be followed by a complete risk factor analysis and modification, if appropriate; a thorough cardiological diagnostic investigation is particularly important. Individual risk indicators for stroke (annual MM 1-2%) are a rapid progression of the degree of stenosis, certain morphological patterns and the presence of extra- and intracranial multi-vessel disease. Trials available so far on the treatment of asymptomatic carotid stenosis have not revealed any significant parameters that would justify individual decisions on whether or not surgery is appropriate. There is therefore a danger that many patients will be exposed to a severe risk of stroke, which cannot be justified unless the centres where such interventions are performed have proven MM complication rates of <3%, the life expectancy of the patients treated is not restricted as the result of other illnesses and the patients explicitly request surgery after a thorough explanation of the risks. Conservative treatment strategies provide the best protection for the majority of patients.
