Die Behandlung der Karotisstenose: Die Sicht des Mikroneurochirurgen

According to the large, randomised, multicentric trials of the 1990’s, carotid-endarterectomy (CEA) is the «gold standard» of treatment for most patients with a proximal stenosis of the internal carotid artery (ACI), especially for those with a high-grade (70–99%), symptomatic stenosis. During the last years CEA has been further refined and standardised. Its results in terms of stroke risk and mortality are so good, that CEAcan be recommended as the prophylactic treatment of choice even in patients with an asymptomatic, highgrade ACI-stenosis and in patients with a 50–69%, evidently symptomatic stenosis, provided that their approximate life expectancy exceeds five years. Today’s scientific evidence, the current results of CEA, but also the analysis of the relevant, known pro’s and con’s of CEA and of the current endovascular treatment options, e.g. carotid angioplasty and stenting (CAS) support the view of CEA being the first option for ACI-stenosis.