Statine und ihr Einfluss auf entzündliche Prozesse in arteriosklerotischen Plaques bei Patienten mit Stenose der Arteria carotis interna

Zusammenfassung

Eine arterioarterielle Embolie ausgehend von hochgradigen Stenosen der Arteria carotis interna ist eine häufige Ursache für zerebrale Ischämien. Entzündliche Prozesse sind nicht nur für die Entstehung, sondern auch für die klinische Destabilisierung arteriosklerotischer Gefäßwandveränderungen von Bedeutung. Innerhalb einer komplexen Pathogenese können Entzündungszellen, wie Makrophagen, durch die Steigerung des proinflammatorischen Milieus, die Produktion von kollagenabbauenden Matrixmetalloproteinasen und die Expression des prothrombogenen Tissue Faktor aus einer chronischen arteriosklerotischen ACI-Stenose einen Hochrisikobereich für die Entstehung arterieller Thromben machen. Damit können diese Prozesse auch die perioperative Komplikationsrate bei Karotisoperationen beeinflussen. Statine sind potente cholesterinsenkende Medikamente. Von der Lipidsenkung unabhängige Effekte scheinen eine wichtige Rolle bei der Verhinderung von vaskulären Ereignissen zu spielen. Eine große Anzahl von Untersuchungen konnte zeigen, dass Statine plaquestabilisierende Effekte haben und die zerebrovaskuläre Autoregulation verbessern. Es gibt zahlreiche Hinweise, die den Nutzen einer präoperativen Gabe von Statinen bei Patienten mit hochgradiger Stenose der Arteria carotis interna belegen.

Abstract

Arterio-arterial emboli originating from a high-grade stenosis of the internal carotid artery are a common cause for cerebral ischemias. Inflammatory processes are not only pivotal in the development of atherosclerotic vessel wall changes, but also for their clinical destabilization. Inflammatory cells, like macrophages, can turn a chronic high-grade carotid stenosis into a high-risk area for the development of arterial thromboses by way of a complex pathogenesis involving the elevation of proinflammatory factors, biosynthesis of collagen-degrading matrix metalloproteinases and expression of prothrombotic tissue factor. This process could affect the occurence of perioperative complications during carotid endarterectomies. Statins are potent cholesterol-lowering agents. Among other lipid-independent effects, statins appear to play a significant role in preventing cardiovascular events. A number of studies have shown that statins possess plaque-stabilizing effects and that they improve cerebral autoregulation. A growing evidence supports the preoperative administration of statins in patients with high-grade stenoses of the internal carotid artery.

Schlüsselwörter

Karotisstenose - Schlaganfall - Endarteriektomie - Statine

Key words

carotid stenosis - stroke - endarterectomy - statins

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