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<p>This article reviews current study results on carotid revascularisation and provides evidence-based therapy recommendations. Key findings include the following. In carotid endarterectomy (CEA), an intraoperative completion study with duplex ultrasound or angiography should be performed routinely. The shunt strategy can be left to the surgeon’s preference and experience. CEA can be safely performed in patients with symptomatic heart failure under local anaesthesia. CEA should be postponed for &gt;5&#xa0;days after intravenous thrombolysis to minimise the risk of intracerebral haemorrhage and bleeding from the throat. Postoperative length of stay is a&#xa0;quality indicator for carotid revascularisation. CEA continues to be the first-line revascularisation for patients with carotid stenosis. Transcarotid arterial revascularisation (TCAR) could be the preferred treatment modality for patients with radiation-induced carotid stenosis. Perioperative stroke risk is low with both TCAR and CEA when the procedure is performed by a&#xa0;surgeon who specialises in one of the two procedures – depending on the case load. Transfemoral carotid stenting should not be performed in patients with chronic kidney disease if CEA or TCAR is anatomically feasible as an alternative.</p>

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Was gibt es Neues bei Carotisendarteriektomie und Carotisstenting? Update 2025

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月22日

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  • Martin Storck,
  • Reinhart T. Grundmann

摘要

This article reviews current study results on carotid revascularisation and provides evidence-based therapy recommendations. Key findings include the following. In carotid endarterectomy (CEA), an intraoperative completion study with duplex ultrasound or angiography should be performed routinely. The shunt strategy can be left to the surgeon’s preference and experience. CEA can be safely performed in patients with symptomatic heart failure under local anaesthesia. CEA should be postponed for >5 days after intravenous thrombolysis to minimise the risk of intracerebral haemorrhage and bleeding from the throat. Postoperative length of stay is a quality indicator for carotid revascularisation. CEA continues to be the first-line revascularisation for patients with carotid stenosis. Transcarotid arterial revascularisation (TCAR) could be the preferred treatment modality for patients with radiation-induced carotid stenosis. Perioperative stroke risk is low with both TCAR and CEA when the procedure is performed by a surgeon who specialises in one of the two procedures – depending on the case load. Transfemoral carotid stenting should not be performed in patients with chronic kidney disease if CEA or TCAR is anatomically feasible as an alternative.