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Karotisstenos

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Definition:
Förträngning i arteria carotis till följd av ateroskleros.
Förekomst:
Asymtomatisk karotisstenos blir vanligare med stigande ålder. Karotisstenos är orsak till 15–20 % av alla ischemiska hjärninfarkter. 
Symtom:
Tillståndet ger i sig inga symtom man kan leda till stroke/TIA.
Kliniska fynd:
Stenosljud kan förekomma. Eventuellt andra tecken på aterosklerotisk sjukdom.
Diagnostik:
Ultraljud kan påvisa karotisstenos med god säkerhet. Angiografi med DT eller MRT kan göras i vissa fall.
Behandling:
Vid asymtomatisk karotisstenos rekommenderas passande förändringar av levnadsvanor, trombocythämmande behandling och ofta statiner/blodtrycksbehandling. Vid symtomgivande karotisstenos med stenos ≥50–99 % kirurgi inom 14 dagar. 
  1. Jonas DE, Feltner C, Amick HR, et al. Screening for asymptomatic carotid artery stenosis: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 161(5): 336-46. pmid:25004169 PubMed  
  2. Raman G, Kitsios GD, Moorthy D, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Aug 27. www.ncbi.nlm.nih.gov  
  3. den Hartog AG, Achterberg S, Moll FL, et al. Asymptomatic carotid artery stenosis and the risk of ischemic stroke according to subtype in patients with clinical manifest arterial disease.. Stroke 2013; 44(4): 1002-7. pmid:23404720 PubMed  
  4. de Weerd M, Greving JP, Hedblad B, et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 2010; 41(6): 1294-7. pmid:20431077 PubMed  
  5. Ahmed B, Al-Khaffaf H. Prevalence of significant asymptomatic carotid artery disease in patients with peripheral vascular disease. A meta-analysis. Eur J Vasc Endovasc Surg 2009; 37: 262-71. PubMed  
  6. Swedvasc. Nationella kvalitetsregistret för kärlkirurgi. Swedvasc’s årsrapport 2019 för 2018 års verksamhet. (Hämtad 2019-08-12). www.ucr.uu.se  
  7. Socialstyrelsen (2018). Nationella riktlinjer för vård vid stroke - stöd för styrning och ledning. (Hämtad 2019-08-12) www.socialstyrelsen.se  
  8. Brott TG, Halperin JL, Abbara S, 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. Circulation. 2011;124:e54-e130. www.ncbi.nlm.nih.gov  
  9. Näslund U, Ng N, Lundrgen A, et al. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet 2019; 393(10167): 133-142. pmid:30522919 PubMed  
  10. Masabni K, Raza S, Blackstone EH, et al. Does preoperative carotid stenosis screening reduce perioperative stroke in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2015; May;149(5): 1253-60. pmid:25816954 PubMed  
  11. Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet 2008; 371: 1587-94. PubMed  
  12. Wardlaw JM, Chappell FM, Stevenson M, et al. Accurate, practical and cost-effective assessment of carotid stenosis in the UK. Health Technol Assess 2006; 10: 1-182. PubMed  
  13. Nederkoorn PJ, VanderGraaf Y, Hunink MGM. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 2003; 34: 1324-32. PubMed  
  14. Paciaroni M, Bogousslavsky J. Antithrombotic therapy in carotid artery stenosis: an update. Eur Neurol 2015; 73(1-2): 51-6. pmid:25402664 PubMed  
  15. Aday AW, Beckman JA. Medical Management of Asymptomatic Carotid Artery Stenosis. Prog Cardiovasc Dis 2017; 59(6): 585-590. pmid:28539213 PubMed  
  16. Vårdriktlinjer för personal inom kommun och Region Kalmar län. Karotisstenos, Primärprevention. 2016-11-09 (Hämtad 2019-08-12) www.vardriktlinjer.se  
  17. Aboyans V, Ricco JB, Bartelink MEL, et al; ESC Scientific Document Group. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO), the Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. Epub 26 aug 2017. PMID:28886620. PubMed  
  18. Dharmakidari S, Bhattacharya P, Chaturvedi S. Carotid Artery Stenosis: Medical Therapy, Surgery, and Stenting. Curr Neurol Neurosci Rep 2017; 17(10): 77. pmid:28825185 PubMed  
  19. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease in prevention in clinicalpractice. Eur J Prev Cardiol 2016;23:NP1-96. academic.oup.com  
  20. Kang S, Wu Y, Li X. Effects of statin therapy on the progression of carotid atherosclerosis: a systematic review and meta-analysis. Atherosclerosis 2004;177(2):433-42. PubMed  
  21. Spence JD. Management of Patients with an Asymptomatic Carotid Stenosis--Medical Management, Endovascular Treatment, or Carotid Endarterectomy? Curr Neurol Neurosci Rep. 2016 Jan;16(1):3.
  22. Rerkasem K, Rothwell PM. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 2011; 13: CD001081. Cochrane (DOI)  
  23. Meier P, Knapp G, Tamhane U, et al. Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled trials. BMJ 2010; 340: c467. BMJ (DOI)  
  24. Brott TG, Hobson RW, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 362: e-pub.
  25. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351: 1493-501. New England Journal of Medicine  
  26. Carotid Stenting Trialist' Collaboration. Short term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 2010; : doi:10.1016/S0140-6736(10)61009-4. DOI  
  27. Paraskevas KI, Kalmykov EL, Naylor AR. Stroke/Death Rates Following Carotid Artery Stenting and Carotid Endarterectomy in Contemporary Administrative Dataset Registries: A Systematic Review. Eur J Vasc Endovasc Surg 2016; Jan;51(1): 3-12. pmid:26346006 PubMed  
  28. Schermerhorn ML, Liang P, Eldrup-Jorgensen J, et al. Association of Transcarotid Artery Revascularization vs Transfemoral Carotid Artery Stenting With Stroke or Death Among Patients With Carotid Artery Stenosis. JAMA 2019; 322: 2313-22. doi:10.1001/jama.2019.18441 DOI  
  29. Barnett HJ, Meldrum HE, Eliasziw M. The appropriate use of carotid endarterectomy. CMAJ 2002; 166: 1169-79. PubMed  
  30. Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361: 107-16. PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Anders Gottsäter, docent och överläkare, Kärlkliniken, Skånes universitetssjukhus