Der Patient mit Karotisstenose

Die Karotisstenose ist eine der häufigsten Ursachen des ischämischen Schlaganfalls und muss sowohl kardiologisch als auch neurologisch betrachtet werden. Besonderer Schwerpunkt dieses Beitrags liegt auf der aktuellen, teilweise kontroversen Debatte um den Stellenwert des Stentings im Vergleich zur Endarteriektomie. Das gebotene Prozedere bei bislang asymptomatischen Patienten mit Karotisstenose nimmt Bezug auf die relevanten Leitlinien.

Schlüsselwörter

Karotisstenose - Stent - Thrombendarteriektomie - Duplexsonografie - Embolieprotektion

• Literatur

• 1 GBD Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-206: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1151-1210
• 2 Statistisches Bundesamt. Im Internet (Stand: 26.09.2021): https://www.destatis.de/DE/Home/_inhalt.html
• 3 The GBD 2016 Lifetime Risk of Stroke Collaborators. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med 2018; 379: 2429-2437
• 4 Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009; 8: 345-354
• 5 Centers for Disease Control and Prevention (CDC). Prevalence and most common causes of disability among adults–United States, 2005. MMWR Morb Mortal Wkly Rep 2009; 58: 421-426
• 6 Kolominsky-Rabas PL, Heuschmann PU, Marschall D. et al. Lifetime Cost of Ischemic Stroke in Germany: Results and National Projections From a Population-Based Stroke Registry. The Erlangen Stroke Project. Stroke 2006; 37: 1179-1183
• 7 Madden KP, Karanjia PN, Adams HP. et al. Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment. Neurology 1995; 45: 1975-1979
• 8 Grau AJ, Weimar C, Buggle F. et al. Risk factors outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 2001; 32: 2559-2566
• 9 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: 1294-1297
• 10 Steinvil A, Sadeh B, Arbel Y. et al. Prevalence and Predictors of Concomitant Carotid and Coronary Artery Atherosclerotic Disease. J Am Coll Cardiol 2011; 57: 779-783
• 11 Morris DR, Ayabe K, Inoue T. et al. Evidence-Based Carotid Interventions for Stroke Prevention: State of-the-art Review. J Atheroscler Thromb 2017; 24: 373-387
• 12 Aboyans V, Ricco JB, Bartelink MEL. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Artery Disease, 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. Eur Heart J 2017; 39: 763-786
• 13 Eckstein H-H, Kühnl A, Berkefeld J. et al. S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der extracraniellen Carotisstenose, 2. Auflage 2020. Im Internet (Stand: 26.09.2021): https://www.awmf.org/uploads/tx_szleitlinien/004-028l_extracranielle-Carotisstenose-Diagnostik-Therapie-Nachsorge_2020-02_03.pdf
• 14 Barnett HJ, Taylor DW, Eliasziw M. et al. Benefitof carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339: 1415-1425
• 15 [No authors listed] Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351: 1379-1387
• 16 Arning C, Widder B, von Reutern GM. et al. Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement. Ultraschall Med 2010; 31: 251-257
• 17 Piepoli MF, Hoes AW, Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37: 2315-2381
• 18 Mayberg MR, Wilson E. Yatsu F et al. for the Veterans Affairs Cooperative Studies Program 309 Trialist Group. Carotid endarterectomy and prevention of cerebral ischaemia in symptomatic carotid stenosis. JAMA 1991; 266: 3289-3294
• 19 Rothwell PM, Eliasziw M, Gutnikov SA. et al. Carotid Endarterectomy Trialistsʼ Collaboration. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361: 107-116
• 20 Rothwell PM, Eliasziw M, Gutnikov SA. et al. Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363: 915-924
• 21 Toole JF, Baker WH, Castaldo JE. et al. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273: 1421-1428
• 22 Halliday A, Mansfield A, Marro J. et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363: 1491-1502
• 23 Mas JL, Chatellier G, Beyssen B. et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006; 355: 1660-1671
• 24 Ringleb PA, Allenberg J, Bruckmann H. et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 2006; 368: 1239-1247
• 25 Bonati LH, Dobson J, Featherstone RL. et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet 2015; 385: 529-538
• 26 Yadav JS, Wholey MH, Kuntz RE. et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351: 1493-1501
• 27 Carotid Stenting Trialistsʼ Collaboration. Bonati LH, Dobson J, Algra A. et al. Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 2010; 376: 1062-1073
• 28 Brott TG, Hobson 2nd RW, Howard G. et al. Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis. N Engl J Med 2010; 363: 11-23
• 29 Rosenfield K, Matsumura JS, Chaturvedi S. et al. Randomized trial of stent versus surgery for asymptomatioc carotid stenosis. N Engl J Med 2016; 374: 1011-1020
• 30 Garg N, Karagiorgos N, Pisimisis GT. et al. Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature. J Endovasc Ther 2009; 16: 412-427
• 31 Naggara O, Touzé E, Beyssen B. et al. Anatomical and Technical Factors Associated With Stroke or Death During Carotid Angioplasty and Stenting Results From the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) Trial and Systematic Review. Stroke 2011; 42: 380-388
• 32 Gray WA, Chaturvedi S, Verta P. et al. Thirty-Day Outcomes for Carotid Artery Stenting in 6320 Patients From 2 Prospective, Multicenter, High-Surgical-Risk Registries. Circ Cardiovasc Intervent 2009; 2: 159-166
• 33 Halliday A, Harrison M, Hayter E. et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 2010; 376: 1074-1084
• 34 Eckstein HH, Reiff T, Ringleb P. et al. SPACE-2: A Missed Opportunity to Compare Carotid Endarterectomy, Carotid Stenting, and Best Medical Treatment in Patients with Asymptomatic Carotid Stenoses. Eur J Vasc Endovasc Surg 2016; 51: 761-765
• 35 Mudra H, Staubach S, Hein-Rothweiler R. et al. Long-term outcomes of carotid artery stenting in clinical practice. Circ Cardiovasc Interv 2016; 9: e003940
• 36 Eckstein H-H, Tsantilas P, Kühnl A. et al. Surgical and Endovascular Treatment of Extracranial Carotid Stenosis: A Secondary Analysis of Statutory Quality Assurance Data From 2009 to 2014. Dtsch Arztebl Int 2017; 114: 729-736
• 37 Bundesauswertung zum Erfassungsjahr 2019: Karotisrevaskularisation Qualitätsindikatoren. Im Internet (Stand: 26.09.2021): https://iqtig.org/downloads/auswertung/2019/10n2karot/QSKH_10n2-KAROT_2019_BUAW_V02_2020-07-14.pdf
• 38 Weimar C, Holst T, Scherag A. et al. Die Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis (Studie.CABACS) RCT Studie. Rationale, Stand und Perspektiven. Gefäßchirurgie 2013; 18: 638-643
• 39 Castriota F, Tomai F, Secco GG. et al. Early and late clinical outcomes of endovascular, surgical, and hybrid revascularization strategies of combined carotid and coronary artery diseases: the FRIENDS study group (Finalized Research In ENDovascular Strategies). Eur Heart J 2015; 17 (Suppl A) A23-A28
• 40 Musialek P, Roubin G. Double-Layer Carotid Stents: From the Clinical Need, through a Stentin-Stent Strategy, to Effective Plaque Isolation the Journey Toward Safe Carotid Revascularization Using the Endovascular Route. J Endovasc Ther 2019; 26: 572-577
• 41 Schneider PA, Levy E, Bacharach JM. et al. A first-in-human evaluation of a novel meshcovered stent for treatment of carotid stenosis in patients at high risk for endarterectomy: 30-day results of the SCAFFOLD trial. JACC Cardiovasc Interv 2018; 11: 2396-2404
• 42 Pasqualino S, Stabile E, Mansour W. et al. 1-Month Results From a Prospective Experience on CAS Using CGuard Stent System The IRONGUARD 2 Study. JACC Cardiovasc Interv 2020; 13: 2170-2177
• 43 de Donato G, Setacci F, Sirignano P. et al. Optical Coherence Tomography after Carotid Stenting: Rate of Stent Malapposition, Plaque Prolapse and Fibrous Cap Rupture According to Stent Design. Eur J Vasc Endovasc Surg 2013; 45: 579-587
• 44 Langhoff R, Schofer J, Scheinert D. et al. Double filtration during carotid artery stenting using a novel post-dilatation balloon with integrated embolic protection. JACC Cardiovasc Interv 2019; 12: 395-403
• 45 Kashyap VS, Schneider PA, Foteh M. et al. Early Outcomes in the ROADSTER 2 Study of Transcarotid Artery Revascularization in Patients With Significant Carotid Artery Disease. Stroke 2020; 51: 2620-2629
• 46 Mudra H. Further down the road?. JACC Cardiovasc Interv 2020; 13: 1716-1717