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Arteriosklerotische Stenosen der extrakraniellen A. carotis: Operative Therapie

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Operative und interventionelle Gefäßmedizin

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Zusammenfassung

Vor nunmehr 100 Jahren wurde zum ersten Mal kontinuitätserhaltend an einer Arteria carotis operiert. Die in den 1950er Jahren entwickelten Operationstechniken (Endarterektomie und Patchplastik sowie Eversionsendarterektomie) stellen auch heute noch die Standardoperationsverfahren bei Stenosebildung im Bereich der Arteria carotis interna dar. Sowohl die intraoperative Qualitätskontrolle (mittels Angiographie oder Sonographie) als auch das intraopeartive Neuromonitoring sollten zum fixen Bestandteil einer Karotis-Operation gehören. Der Eingriff wird mittlerweile häufig in lokoregionärer Anästhesie durchgeführt. Ende der 1990er konnte in internationalen multizentrischen randomisierten Studien gezeigt werden, dass die Operation in der Schlaganfallprophylaxe bei Patientinnen und Patienten mit symptomatischer Stenose hoch effektiv ist. Weiterführende Auswertungen belegten, dass Frauen weniger von der invasiven Behandlungstechnik profitieren als Männer und dass die Operation innerhalb von 2 Wochen nach Beginn der neurologischen Symptomatik durchgeführt werden sollte. Auch bei Patientinnen und Patienten mit asymptomatischer Karotis-Stenose bringt die Operation einen Benefit in der Schlaganfallprävention. Neben lokalen Komplikationen im Operationsfeld (Hirnnervenläsionen, Nachblutung, Infektionen) kann es auch zu neurologischen (ischämischer Schlaganfall oder Einblutungen) und systemischen Zwischenfällen (Myokardinfarkt, respiratorische Komplikationen) im Rahmen einer Karotis-Operation kommen.

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Literatur

  • Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R et al (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373(9678):1849–1860

    Article  CAS  PubMed  Google Scholar 

  • Bennett KM, Scarborough JE, Shortell CK (2015) Risk factors for cranial nerve injury after carotid endarterectomy. J Vasc Surg 62(2):363–368

    Article  PubMed  Google Scholar 

  • Bisdas T, Egorova N, Moskowitz AJ, Sosunov EA, Marin ML, Faries PL et al (2012) The impact of gender on in-hospital outcomes after carotid endarterectomy or stenting. Eur J Vasc Endovasc Surg 44(3):244–250

    Article  CAS  PubMed  Google Scholar 

  • Blackshear JL, Cutlip DE, Roubin GS, Hill MD, Leimgruber PP, Begg RJ et al (2011) Myocardial infarction after carotid stenting and endarterectomy: results from the carotid revascularization endarterectomy versus stenting trial. Circulation 123(22):2571–2578

    Article  PubMed  PubMed Central  Google Scholar 

  • Bond R, Rerkasem K, Naylor AR, Aburahma AF, Rothwell PM (2004a) Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. J Vasc Surg 40(6):1126–1135

    Article  CAS  PubMed  Google Scholar 

  • Bond R, Rerkasem K, Naylor R, Rothwell PM (2004b) Patches of different types for carotid patch angioplasty. Cochrane Database Syst Rev (2):CD000071

    Google Scholar 

  • Bond R, Rerkasem K, Cuffe R, Rothwell PM (2005) A systematic review of the associations between age and sex and the operative risks of carotid endarterectomy. Cerebrovasc Dis 20(2):69–77

    Article  CAS  PubMed  Google Scholar 

  • Boulanger M, Cameliere L, Felgueiras R, Berger L, Rerkasem K, Rothwell PM et al (2015) Periprocedural myocardial infarction after carotid endarterectomy and stenting: systematic eeview and meta-analysis. Stroke 46(10):2843–2848

    Article  CAS  PubMed  Google Scholar 

  • Brott TG, Hobson RW, Howard G, Roubin GS, Clark WM, Brooks W et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363(1):11–23

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL et al (2011) ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 124:489–532

    Google Scholar 

  • Cao PG, De RP, Zannetti S, Giordano G, Ricci S, Celani MG (2001) Eversion versus conventional carotid endarterectomy for preventing stroke. Cochrane Database Syst Rev (1):CD001921

    Google Scholar 

  • Cao P, De RP, Zannetti S (2002) Eversion vs conventional carotid endarterectomy: a systematic review. Eur J Vasc Endovasc Surg 23(3):195–201

    Article  CAS  PubMed  Google Scholar 

  • Carrel A (1906) Uniterminal and biterminal venous transplantations. Surg Gynecol Obstet 2:266–286 (Report No.: 2)

    Google Scholar 

  • Carrel A (1908) Results of transplantation of blood vessels, organs and limbs. JAMA 51:1662 (Report No.: 51)

    Article  Google Scholar 

  • Carrel A, Morel B (1902) Anastomose bout a bout de la jugulaire et de la carotide primitive. Lyon Med 99:114–116 (Report No.: 99)

    Google Scholar 

  • Chongruksut W, Vaniyapong T, Rerkasem K (2014) Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev (6):CD000190

    Google Scholar 

  • Cogswell M (1824) Account of an operation for the extirpation of a tumour in which a ligature was applied to the carotid artery. N Engl J Med 13:357–360 (Report No.: 13)

    Article  Google Scholar 

  • Cooper A (1809) Second case of a carotid aneurysm. Me Chir Trans 1:222–223 (Report No.: 1)

    Google Scholar 

  • Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M et al (2004) Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 364(9431):331–337

    Article  CAS  PubMed  Google Scholar 

  • Eckstein HH, Assadian A, Kühnl A, Berger H (2012) Supraaortale Gefäße. In: Debus ES, Gross-Fengels (Hrsg) Operative und interventionelle Gefäßmedizin. Springer, Berlin, S 381–421

    Chapter  Google Scholar 

  • Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC et al (1999) The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 30(9):1751–1758

    Article  CAS  PubMed  Google Scholar 

  • Fields WS, Lemak NA, Frankowski RF, Hardy RJ, Bigelow RH (1980) Controlled trial of aspirin in cerebral ischemia. Circulation 62(6 Pt 2):V90–V96

    PubMed  CAS  Google Scholar 

  • Fraedrich G (2004) Re: from Hippocrates to Palmaz-Schatz, the history of carotid surgery. Eur J Vasc Endovasc Surg 28(4):455

    Article  CAS  PubMed  Google Scholar 

  • Gasecki AP, Eliasziw M, Ferguson GG, Hachinski V, Barnett HJ (1995) Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. J Neurosurg 83(5):778–782

    Article  CAS  PubMed  Google Scholar 

  • Gent M (1999) The CAPRIE trial: culmination of the preregistration program for clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events. Clopidogrel versus aspirin in patients at risk of ischaemic events. Semin Thromb Hemost 25(Suppl 2):1–2

    PubMed  Google Scholar 

  • Gluck T (1898) Die moderne chirurgie des circulations apparates. Berl Klin 129:1–29 (Report No.: 129)

    Google Scholar 

  • Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J et al (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363(9420):1491–1502

    Article  CAS  PubMed  Google Scholar 

  • Halliday A, Harrison M, Hayter E, Kong X, Mansfield A, Marro J et al (2010) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 376(9746):1074–1084

    Article  PubMed  PubMed Central  Google Scholar 

  • Hankey GJ, Johnston SC, Easton JD, Hacke W, Mas JL, Brennan D et al (2011) Effect of clopidogrel plus ASA vs. ASA early after TIA and ischaemic stroke: a substudy of the CHARISMA trial. Int J Stroke 6(1):3–9

    Article  PubMed  Google Scholar 

  • Ho KJ, Madenci AL, McPhee JT, Semel ME, Bafford RA, Nguyen LL et al (2014) Contemporary predictors of extended postoperative hospital length of stay after carotid endarterectomy. J Vasc Surg 59(5):1282–1290

    Article  PubMed  Google Scholar 

  • Jaboulay M (1902) Chirurgie des arteres, ses applications aquelques lesions de l’artere femoral. Semin Med 22:405–406 (Report No.: 22)

    Google Scholar 

  • Jones DW, Goodney PP, Conrad MF, Nolan BW, Rzucidlo EM, Powell RJ et al (2016) Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy. J Vasc Surg 63(5):1262–1270

    Article  PubMed  PubMed Central  Google Scholar 

  • Kakisis JD, Avgerinos ED, Antonopoulos CN, Giannakopoulos TG, Moulakakis K, Liapis CD (2012) The European society for vascular surgery guidelines for carotid intervention: an updated independent assessment and literature review. Eur J Vasc Endovasc Surg 44(3):238–243

    Article  CAS  PubMed  Google Scholar 

  • Kakkos SK, Nicolaides AN, Charalambous I, Thomas D, Giannopoulos A, Naylor AR et al (2013) Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis. J Vasc Surg 59(4):956–967

    Article  PubMed  Google Scholar 

  • Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, Torgerson D et al (2008) General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 372(9656):2132–2142

    Article  CAS  PubMed  Google Scholar 

  • Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J et al (2009) ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 37(4 Suppl):1–19

    Article  CAS  PubMed  Google Scholar 

  • Maertens V, Maertens H, Kint M, Coucke C, Blomme Y (2016) Complication rate after carotid endarterectomy comparing patch angioplasty and primary closure. Ann Vasc Surg 30:248–252

    Article  PubMed  Google Scholar 

  • Moulakakis KG, Mylonas SN, Sfyroeras GS, Andrikopoulos V (2009) Hyperperfusion syndrome after carotid revascularization. J Vasc Surg 49(4):1060–1068

    Article  PubMed  Google Scholar 

  • Nwachuku EL, Balzer JR, Yabes JG, Habeych ME, Crammond DJ, Thirumala PD (2015) Diagnostic value of somatosensory evoked potential changes during carotid endarterectomy: a systematic review and meta-analysis. JAMA Neurol 72(1):73–80

    Article  PubMed  Google Scholar 

  • Paciaroni M, Eliasziw M, Kappelle LJ, Finan JW, Ferguson GG, Barnett HJ (1999) Medical complications associated with carotid endarterectomy. North American Symptomatic Carotid Endarterectomy Trial (NASCET). Stroke 30(9):1759–1763

    Article  CAS  PubMed  Google Scholar 

  • Pandit JJ, Satya-Krishna R, Gration P (2007) Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth 99(2):159–169

    Article  CAS  PubMed  Google Scholar 

  • Pare A (1968) The works of that famous chirurgion Ambrose Parey. Translated out of Latin and compared with the French by Thomas Johnson: from the first English edition. New York, Verlag Milford House

    Google Scholar 

  • Paty PS, Darling RC III, Feustel PJ, Bernardini GL, Mehta M, Ozsvath KJ et al (2004) Early carotid endarterectomy after acute stroke. J Vasc Surg 39(1):148–154

    Article  PubMed  Google Scholar 

  • Pennekamp CW, Bots ML, Kappelle LJ, Moll FL, de Borst GJ (2009) The value of near-infrared spectroscopy measured cerebral oximetry during carotid endarterectomy in perioperative stroke prevention. A review. Eur J Vasc Endovasc Surg 38(5):539–545

    Article  CAS  PubMed  Google Scholar 

  • Pennekamp CW, Immink RV, den Ruijter HM, Kappelle LJ, Bots ML, Buhre WF et al (2013) Near-infrared spectroscopy to indicate selective shunt use during carotid endarterectomy. Eur J Vasc Endovasc Surg 46(4):397–403

    Article  CAS  PubMed  Google Scholar 

  • Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) (1998). Lancet 351(9113):1379–1387

    Google Scholar 

  • Rantner B, Kollerits B, Schmidauer C, Willeit J, Thauerer M, Rieger M et al (2011) Carotid endarterectomy within seven days after the neurological index event is safe and effective in stroke prevention. Eur J Vasc Endovasc Surg 42(6):732–739

    Article  CAS  PubMed  Google Scholar 

  • Rantner B, Schmidauer C, Knoflach M, Fraedrich G (2015) Very urgent carotid endarterectomy does not increase the procedural risk. Eur J Vasc Endovasc Surg 49(2):129–136

    Article  CAS  PubMed  Google Scholar 

  • Riles TS (1994) 3. Surgical management of internal carotid artery stenosis: preventing complications. Can J Surg 37(2):124–127

    PubMed  CAS  Google Scholar 

  • Riles TS, Imparato AM, Jacobowitz GR, Lamparello PJ, Giangola G, Adelman MA et al (1994) The cause of perioperative stroke after carotid endarterectomy. J Vasc Surg 19(2):206–214

    Article  CAS  PubMed  Google Scholar 

  • Robicsek F, Roush TS, Cook JW, Reames MK (2004) From Hippocrates to Palmaz-Schatz, the history of carotid surgery. Eur J Vasc Endovasc Surg 27(4):389–397

    Article  CAS  PubMed  Google Scholar 

  • Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ (2004a) Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 363(9413):915–924

    Article  CAS  Google Scholar 

  • Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ (2004b) Sex difference in the effect of time from symptoms to surgery on benefit from carotid endarterctomy for transient ischemic attack and nondisabling stroke? Stroke 35(12):2855–2861

    Article  CAS  PubMed  Google Scholar 

  • Russell DA, Gough MJ (2004) Intracerebral haemorrhage following carotid endarterectomy. Eur J Vasc Endovasc Surg 28(2):115–123

    Article  CAS  PubMed  Google Scholar 

  • Sharpe R, Sayers RD, London NJ, Bown MJ, McCarthy MJ, Nasim A et al (2013) Procedural risk following carotid endarterectomy in the hyperacute period after onset of symptoms. Eur J Vasc Endovasc Surg 46(5):519–524

    Article  CAS  PubMed  Google Scholar 

  • Stehr A, Scodacek D, Wustrack H, Steinbauer M, Topel I, Pfister K et al (2008) Retrojugular versus ventrojugular approach to carotid bifurcation for eversion endarterectomy: a prospective randomized trial. Eur J Vasc Endovasc Surg 35(2):190–195

    Article  CAS  PubMed  Google Scholar 

  • Stromberg S, Gelin J, Osterberg T, Bergstrom GM, Karlstrom L, Osterberg K (2012) Very urgent carotid endarterectomy confers increased procedural risk. Stroke 43(5):1331–1335

    Article  PubMed  Google Scholar 

  • Tan TW, Garcia-Toca M, Marcaccio EJ Jr, Carney WI Jr, Machan JT, Slaiby JM (2009) Predictors of shunt during carotid endarterectomy with routine electroencephalography monitoring. J Vasc Surg 49(6):1374–1378

    Article  PubMed  Google Scholar 

  • Taylor DW, Barnett HJ, Haynes RB, Ferguson GG, Sackett DL, Thorpe KE et al (1999) Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet 353(9171):2179–2184

    Article  CAS  PubMed  Google Scholar 

  • Vaniyapong T, Chongruksut W, Rerkasem K (2013) Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev (12):CD000126

    Google Scholar 

  • Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351(15):1493–1501

    Article  CAS  PubMed  Google Scholar 

  • Young B, Moore WS, Robertson JT, Toole JF, Ernst CB, Cohen SN et al (1996) An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Artheriosclerosis Study. Stroke 27(12):2216–2224

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universitätsklinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich

    Barbara Rantner & Gustav Fraedrich

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  1. Barbara Rantner
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  2. Gustav Fraedrich
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Correspondence to Barbara Rantner .

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  1. Allgemeines Krankenhaus Harburg, Hamburg, Germany

    Eike Sebastian Debus

  2. Radiologie, Allgemeines Krankenhaus Harburg Abt. Diagnostische und Interventionelle, Hamburg, Germany

    Walter Gross-Fengels

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Rantner, B., Fraedrich, G. (2017). Arteriosklerotische Stenosen der extrakraniellen A. carotis: Operative Therapie. In: Debus, E., Gross-Fengels, W. (eds) Operative und interventionelle Gefäßmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45856-3_51-1

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  • DOI: https://doi.org/10.1007/978-3-662-45856-3_51-1

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