Department of Vascular and Endovascular Surgery/Vascular Center, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Dtsch Arztebl Int. 2013 Jul;110(27-28):468-76. doi: 10.3238/arztebl.2013.0468. Epub 2013 Jul 8.
Extracranial atherosclerotic lesions of the carotid bifurcation cause 10% to 20% of all cases of cerebral ischemia. Until now, there have been no comprehensive evidence- and consensus-based recommendations for the management of patients with extracranial carotid stenosis in Germany and Austria.
The literature was systematically searched for pertinent publications (1990-2011). On the basis of 182 randomized clinical trials (RCTs) and 308 systematic reviews, 30 key questions were answered and evidence-based recommendations were issued.
The prevalence of extracranial carotid stenosis is more than 5% from age 65 onward. Men are affected twice as frequently as women. The most important diagnostic technique is Doppler- and color-coded duplex ultrasonography. RCTs have shown that the treatment of high-grade asymptomatic carotid stenosis with carotid endarterectomy (CEA) can lower the 5-year risk of stroke from 11% to 5%. Intensive conservative treatment may lower the stroke risk still further. Moreover, RCTs have shown that CEA for symptomatic 50% to 99% carotid stenosis lowers the 5-year stroke risk by 5% to 16%. Meta-analyses of the 13 available RCTs comparing carotid artery stenting (CAS) with CEA have shown that CAS is associated with a 2% to 2.5% higher risk of periprocedural stroke or death and with a 0.5% to 1% lower risk of periprocedural myocardial infarction. If no particular surgical risk factors are present, CEA is the standard treatment for high-grade carotid stenosis. CAS may be considered as an alternative to CEA if the rate of procedure-related stroke or death can be kept below 3% or 6% for asymptomatic and symptomatic stenosis, respectively.
Further studies are needed so that better selection criteria can be developed for individually tailored treatment.
颅外颈动脉分叉处的动脉粥样硬化病变导致 10%至 20%的所有脑缺血病例。到目前为止，德国和奥地利还没有针对颅外颈动脉狭窄患者管理的全面循证和共识推荐。
系统地搜索了相关文献（1990-2011 年）。基于 182 项随机临床试验（RCT）和 308 项系统评价，回答了 30 个关键问题，并提出了基于证据的推荐意见。
颅外颈动脉狭窄的患病率从 65 岁起超过 5%。男性的患病率是女性的两倍。最重要的诊断技术是多普勒和彩色双功能超声检查。RCT 表明，颈动脉内膜切除术（CEA）治疗无症状高分级颈动脉狭窄可将 5 年中风风险从 11%降低至 5%。强化保守治疗可能进一步降低中风风险。此外，RCT 表明，症状性 50%至 99%颈动脉狭窄的 CEA 可使 5 年中风风险降低 5%至 16%。比较颈动脉支架置入术（CAS）与 CEA 的 13 项可用 RCT 的荟萃分析表明，CAS 与围手术期卒中或死亡风险增加 2%至 2.5%相关，围手术期心肌梗死风险降低 0.5%至 1%。如果没有特定的手术危险因素，CEA 是高分级颈动脉狭窄的标准治疗方法。如果无症状和症状性狭窄的相关卒中或死亡发生率分别可控制在 3%或 6%以下，则 CAS 可作为 CEA 的替代方法。
需要进一步研究，以便为个体化治疗制定更好的选择标准。
