Karotisrevaskularisation

Despite intensified efforts with the expansion of stroke units, stroke still represents a relevant health economic aspect and is still top of the list of reasons for an invalidism of older people. With the help of best medical treatment (BMT) the natural stroke risk due to extracranial stenosis of the internal carotid artery (ICA) could be relevantly reduced in recent years. This increases the demands on the performance of procedures for revascularization (carotid endarterectomy and carotid artery stenting); however, despite intensified BMT there are still patients who show plaque characteristics and morphological criteria that result in an increased risk of stroke in the natural course. In patients with symptomatic ICA stenosis surgery remains the gold standard. The operation should be performed within 3–7 days after the neurological index event, depending on the cerebral findings. For some years now, transcarotid artery revascularization (TCAR) has been used as an alternative to transfemoral carotid artery stenting. Randomized evidence for assessment of the comparability of this procedure with surgery or classical carotid artery stenting is so far missing. The evaluation of register data indicates that better results are achieved with TCAR than with transfemoral stent treatment.