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Nervenheilkunde 2006; 25(12): 997-1002
DOI: 10.1055/s-0038-1626810
Arbeiten zum Schwerpunkt - Theme Articles
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Die Revaskularisation der A. carotis zur Schlaganfallprophylaxe

Carotid revascularization for prevention of stroke
R. Brandl
1   Klinik für Gefäßchirurgie, Klinikum München Schwabing
,
H. Stiegler
2   Klinik für Angiologie, Klinikum München Schwabing
› Author Affiliations
Further Information

Publication History

Publication Date:
19 January 2018 (online)

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Zusammenfassung

Die Endarteriektomie der A. carotis ist bisher das einzige auf höchstem Evidenzniveau geprüfte invasive Verfahren zur Schlaganfallprophylaxe. Wichtigste Kriterien für die Dringlichkeit der Indikationsstellung sind patientenseitig der Stenosegrad sowie Art und Schweregrad der Symptomatik. Auf Seiten der therapeutischen Einheit steht dagegen das zentrumsspezifische periprozedurale Eingriffsrisiko. Mit Entwicklungen der Operationstechnik sowie des perioperativen Managements sind in erfahrenen Zentren sehr niedrige kombinierte Komplikationsraten zu erzielen, die mit ca. 1% für asymptomatische und2 bis 4% Morbidität und Mortalität für symptomatische Stenosen unterhalb der von den internationalen Fachgesellschaften empfohlenen Richtwerte von 3 bzw. 6% liegen. Künftige Entwicklungen in der Diagnostik zielen auf die Charakterisierung der Plaquemorphologie zur Definition besonderer Risikogruppen. Zunehmende Erfahrung und Verbesserungen der Infrastruktur lassen einen vermehrten Einsatz der CEA zur Behandlung neurologischer Ausfälle bei akuter Karotisinsuffizienz erwarten. Die Frage, welchen Stellenwert die Stentangioplastie im Vergleich zur Operation hat, wird sich demnächst aus der Metaanalyse derzeit noch laufender Studien ergeben.

Summary

Hitherto, carotid endarterectomy is the only invasive procedure for stroke prevention being evaluated by level A of evidence. The pivotal criteria for indication are degree of stenosis, type and severity of neurological symptoms as well as, on the other hand, institutional periprocedural risk. Along with developments of surgical technique and perioperative management, complication rates have been minimized in experienced centres to a level of 1% combined morbidity and mortality for asymptomatic and2 to 4% for symptomatic stenosis, thereby fulfilling the recommendations of international scientific societies of 3 and 6% respectively. Evolution of diagnostic instruments aims at morphological plaque characterization for more reliable definition of patients at risk. Growing experience and further amelioration of infrastructural conditions may contribute toa more common use of surgery for acute carotid insufficiency in emergency. The value of stent angioplasty is still being debated controversial and may evolve from meta-analyses of randomised controlled trials being completed in the near future.

Schlüsselwörter

Schlaganfall - Prävention - Karotisstenose - chirurgische Therapie - Stentangioplastie

Keywords

Stroke - prevention - carotid stenosis - surgical therapy - stent angioplasty
 

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