Fortschritte in der interventionellen Neuroradiologie

Zusammenfassung

In der Neuroradiologie ergeben sich aufgrund technischer Neuerungen Fortschritte in den Interventionen mit Relevanz für den klinischen Alltag. In der Akuttherapie des Schlaganfalls kommen vermehrt endovaskuläre Behandlungsverfahren zum Einsatz, durch die deutlich höhere Rekanalisationsraten als bei alleiniger intravenöser Lyse erzielt werden. Für die Behandlung extrakranieller Gefäßstenosen gibt es Hinweise, dass das Karotisstenting in manchen Fällen eine Therapiealternative zur Operation darstellt. Ausgewählte intrakranielle Gefäßstenosen sind risikoarm und effizient durch PTA und Stentimplantation auf endovaskulärem Weg behandelbar. Im nicht invasiven Monitoring von möglichen Reststenosen sind Angiografiesysteme mit Flachbilddetektoren in Kombination mit einer intravenösen Kontrastmittelgabe hilfreich. In der Aneurysmatherapie werden zunehmend Stents mit besonderer Oberflächenstruktur (Flow Diverter) zur Behandlung komplexer zerebraler Aneurysmen eingesetzt. Breitbasige Aneurysmen können mit der Ballon-remodeling-Technik behandelt werden. Durch den Einsatz von Flüssigembolisaten und speziellen Mikrokathetern hat sich die Verschlussrate von arteriovenösen Malformationen verbessert.

Summary

In acute stroke therapy endovascular treatment procedures are increasingly applied, which lead to significant higher recanalization rates than intravenous lysis. For treatment of extracranial vessel stenoses carotid stenting emerged in comparative studies as an effective therapeutic option to surgery in selected cases. Also selected intracranial vessel stenoses can be treated low-risk and efficient by PTA and stent deployment by the endovascular way. In combination with intravenous contrast agent administration flatpanel detector angiography systems are helpful for the non invasive monitoring of possible restenoses. In aneurysm therapy increasingly stents with special surface structure, flow diverter, are used for treatment of complex cerebral aneurysms. Broad based aneurysms can be treated by balloon-remodeling technique. By using liquid embolic agents and special microcatheters the occlusion rate of arteriovenous malformations has improved.

Schlüsselwörter

Neuroradiologie - endovaskuläre Interventionen - zerebrovaskuläre Erkrankungen

Keywords

Neuroradiology - endovascular interventions - cerebrovascular diseases

• Literatur

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