Carotid artery stenosis
Surgery and stent are equally successful in stroke prevention
Patients who have suffered strokes due to stenosis of the carotid artery are at a high risk of suffering further strokes. Many of these second strokes could be avoided if the stenosis was treated in time. This can be done in two ways: Surgical removal of plaque during the endarterectomy, or catheter treatment with a stent being inserted under local anaesthetic, to prevent another stenosis occurrence.
Doctors have been discussing for years which of those two procedures is more successful. Now new findings prove that the chances of long-term success are the same. However, there are big differences regarding the complication rates in individual treatment centres. Therefore the German Stroke Society advises those affected to find out about the complication rates in their respective centres prior to undergoing treatment.
Calcifications in the carotid artery are one of the main causes of strokes. Once such narrowing has occurred and led to a stroke, there is a high risk of the patient suffering a repeat stroke. ‘Around every 7th patient who has suffered a stroke because of stenosis of the carotid artery suffers a further stroke in the same year. If the narrowing is removed this will ‘only’ happen to every 25th patient,’ explains Professor Martin Grond MD, Member of the Board at the German Stroke Society and senior consultant at the Kreisklinikum Siegen.
Arterial occlusion can be treated surgically but also with minimally-invasive procedures: Vascular surgeons can remove the calcifications and fatty deposits surgically. For some time it has also been possible to treat a patient with a minimum-invasive procedure without the need for surgery – the patient is given a local anaesthetic and the doctor guides a balloon catheter into the vessel, which opens up the restricted area. A stent is then inserted to prevent the recurrence of stenosis.
In several studies, doctors have investigated the chances of success and respective complication rates of the surgical procedure on the one hand and the insertion of a stent on the other. The results of follow-up observation from three large, comparative trials have now shown that both procedures show no significant differences in the long term. The French EVA-3S study showed that, four years after treatment, patients in both groups suffered roughly the same number of further strokes. The two-year results of the SPACE study, carried out in Germany, Austria and Switzerland, appear to confirm this, along with the three-year results of the American SAPPHIRE study.
‘In the medium and long term both procedures achieve comparable results,’ concludes Professor Grond. ‘However, we’ve also discovered that the differences regarding complication rates in different treatment centres are significant. This is something patients should consider in their choice of treatment centre. According to the professor, one aid in their decision-making could be the complication rates published in the quality reports of these centres. Each Centre of Intervention should additionally publish a register of complications so that patient can get an overview at first glance. It is important that this is done in cooperation with a neurologist.’ In this context it is also important to mention that this is only relevant in cases of stenosis of the carotid artery, where it has already caused stroke-like symptoms — a transient ischaemic attack (TIA). Prof Grond advises: ‘If an examination shows up a stenosis of the carotid artery by chance this must not necessarily be treated surgically or with the insertion of a stent – treatment with medication is also an option.’
19.11.2008
