Comparison of long-term results of carotid endarterectomy for asymptomatic carotid artery stenosis
| Autor: | S. Demirel, Dittmar Böckler, Martin Storck |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Asymptomatische Stenose Carotid endarterectomy 030204 cardiovascular system & hematology Karotisendarterektomie Arteria carotis interna Asymptomatic law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine.artery Internal medicine Asymptomatic stenosis Leitthema Medicine 030212 general & internal medicine Myocardial infarction Stroke Evidence business.industry Perioperative Vascular surgery medicine.disease Karotisstent Evidenz Cardiology Surgery medicine.symptom Internal carotid artery Cardiology and Cardiovascular Medicine business Carotid artery stenting |
| Zdroj: | Gefasschirurgie |
| ISSN: | 0948-7034 |
| Popis: | This article summarizes the current study situation on treatment of asymptomatic carotid artery stenosis and discusses the evidence situation in the literature. The 10-year results of the ACST study have shown that in comparison to conservative treatment, carotid endarterectomy (CEA) has retained a positive long-term effect on the reduction of all forms of stroke. All multicenter randomized controlled trials comparing CEA with carotid artery stenting (CAS) and, in particular the SAPHIRE and CAVATAS studies, have in common that despite a basic evidence level of Ib, the case numbers of asymptomatic patients are too small for a conclusive therapy recommendation. In the overall assessment of the CREST study the resulting difference in the questionable endpoint of "perioperative myocardial infarction" in favor of the CAS methods, could not be confirmed for exclusively asymptomatic patients. In the long-term course of the CREST study, both methods were classified as equivalent, even when the 4‑year results of periprocedural and postprocedural stroke rates in the separate assessment of the asymptomatic study participants clearly favored the CEA. The results of the ACST-1 study showed an equivalent effect of both treatment methods with respect to all investigated endpoints; however, the unequal sizes of the groups in addition to the statistically insufficient case numbers put a question mark on the validity of the study results. The results of the ASCT-2 and CREST-2 studies are to be awaited, which also investigate the significance of "CEA versus CAS" (ASCT-2) and "CEA/CAS + best medical treatment (BMT) versus BMT alone" in only asymptomatic stenoses. The current S3 guidelines allow operative therapy to be considered in patients with a 60-99% asymptomatic carotid artery stenosis, because the risk of stroke is statistically significantly reduced.Der folgende Artikel fasst die aktuelle Studienlage zur Therapie der symptomfreien Karotisstenose zusammen und diskutiert deren Evidenzlage in der Literatur. Die 10-Jahres-Ergebnisse der ACST-1-Studie haben gezeigt, dass die Karotisendaretrektomie (CEA) im Vergleich zur konservativen Therapie ihren positiven Langzeiteffekt in der Reduktion jedweder Schlaganfälle beibehalten hat. Alle multizentrisch randomisiert kontrollierten Studien mit dem Vergleich CEA versus Stent ( |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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