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01.12.2014 | Main Topic

Management of atherosclerotic supraaortic lesions

verfasst von: K. Linni, MD, M. Aspalter, MD, P. Metzger, MD, Prof. H. Magometschnigg, Prof. T. Hölzenbein

Erschienen in: European Surgery | Ausgabe 6/2014

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Abstract

Background

Prevention of cerebrovascular ischemic lesions due to atherosclerotic occlusive disease (AOD) of supraaortic vessels plays a major role in the daily workload of a vascular surgeon. The aim of this study was to give an overview of current endovascular and surgical treatment options for patients suffering from internal carotid artery (ICA), vertebral artery (VA), proximal subclavian artery (SA), and common carotid artery (CCA) AOD within a modern multidisciplinary management concept.

Methods

A systemic review of the literature on management of supraaortic AOD was undertaken. Medline (1995–2014) and Cochrane Electronic Databases (2014) were searched for publications dealing with surgical and endovascular treatment of ICA, VA, SA, and/or CCA lesions, respectively.

Results

ICA stenosis is the most common supraaortic lesion and is regarded as an indicator for endarterectomy (eversion or standard) in both symptomatic and asymptomatic patients. Percutaneous transluminal angioplasty (PTA) with stent should be restricted to patients with hostile neck, contralateral laryngeal nerve palsy, high-grade restenosis, or very distal ICA stenosis. Other supraaortic lesions like VA, SA, and CCA stenosis/occlusion were initially operated via a transthoracic approach but high complication rates brought extrathoracic surgical techniques forward. Since the 1980s PTA with its minimally invasive character and its progressive stent technology has become the treatment of choice for patients with VA, SA, or CCA lesions.

Conclusions

Primary ICA stenosis should be treated by endarterectomy first. All other supraaortic lesions should be managed endovascularly but surgery poses a good treatment alternative if endovascular management fails or is contraindicated.

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Titel: Management of atherosclerotic supraaortic lesions
verfasst von: K. Linni, MD
M. Aspalter, MD
P. Metzger, MD
Prof. H. Magometschnigg
Prof. T. Hölzenbein
Publikationsdatum: 01.12.2014
Verlag: Springer Vienna
Erschienen in: European Surgery / Ausgabe 6/2014
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-014-0268-6