Komplexe Koronarinterventionen

Die koronare Herzerkrankung (KHK) gehört weltweit zu den führenden Todesursachen. Medikamentöse Therapie, die perkutane koronare Intervention (PCI) und Bypassoperation sind die therapeutischen Möglichkeiten der KHK. Bei der PCI gehören Bifurkationsstenosen, kalzifizierte Läsionen und chronische Koronarverschlüsse zu den besonderen Herausforderungen.

Kernaussagen

• Die primäre Behandlungsstrategie koronarer Bifurkationsstenosen basiert auf der Stentimplantation im Hauptast mit nur bedarfsweiser Stentimplantation im Seitenast („provisional“ T-Stenting).

• Zwei-Stent-Techniken wie TAP-, Culotte- und DK-Crush-Stenting sind in ca. 20% der Fälle erforderlich, um ein optimales angiografisches Ergebnis zu erzielen.

• Die aktuelle Datenlage unterstützt den Einsatz der DK-Crush-Technik bei der PCI der linken Hauptstammstenose.

• Eine optimale Plaquemodifikation ist bei einer PCI stark verkalkter Koronargefäße der wesentliche Schlüssel zum Erfolg.

• Dabei können Verfahren wie die Rotablation und die Ultrahochdruckangioplastie zu einer verbesserten Stentapposition und Stentexpansion verhelfen.

• CTOs finden sich bei ca. 20% aller angiografierten Patienten. Nicht selten liegt eine reine Belastungsdyspnoe als führendes Symptom vor.

• Die Indikation zur Rekanalisierung einer CTO wird symptomorientiert oder nach Ischämie- und Vitalitätsnachweis gestellt. Patienten mit Mehrgefäßerkrankung sollten, wenn immer möglich, komplett unter Miteinbeziehung der CTO revaskularisiert werden.

Schlüsselwörter

perkutane koronare Intervention - Bifurkationsstenting - chronische Koronarverschlüsse (CTO) - Rotablation - kalzifizierte Koronarläsionen

• Literatur

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