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Der Klinikarzt 2019; 48(05): 192-199
DOI: 10.1055/a-0900-2105
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Karotisstenose

State of the art
Harald Mudra
1   Herz-Gefäss-Zentrum Nymphenburg am Klinikum Dritter Orden, München
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Publication History

Publication Date:
21 May 2019 (online)

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ZUSAMMENFASSUNG

Obwohl durch ischämische Hirninfarkte verursachte Schlaganfälle seit 1990 abgenommen haben, stehen sie immer noch an 2. Stelle der Todesursachen weltweit und an 3. Stelle in Deutschland. Etwa 10–15 % der Schlaganfälle werden durch Verengungen der extrakraniellen hirnversorgenden Arterien, vornehmlich im Bereich der a. carotis, verursacht. Die Diagnose einer Karotisstenose erfolgt durch die Duplex-Sonografie. Sie weist eine sehr hohe Präzision auf und ist der Goldstandard hinsichtlich der Stenosequantifizierung. Patienten mit nachgewiesener Karotisstenose von über 50 % gelten als Hoch-Risiko-Patienten. Sie bedürfen einer konsequenten präventiven Beratung zur Verbesserung des Lebensstils und Reduktion eines deutlichen Übergewichts, zudem ist die Einleitung und ggf. Eskalierung einer optimalen medikamentösen Therapie (OMT) essenziell. Die operative Behandlung von symptomatischen Patienten mit hochgradigen Karotisstenosen zur Verhinderung eines Schlaganfalls ist akzeptiert und gilt als Goldstandard. Neuere, anglo-amerikanische Studien haben gezeigt, dass das Stenting von Karotisstenosen in ausgewiesenen Zentren eine ebenbürtige Methode ist. Entscheidender als die Behandlungsmethode scheint die jeweilige Expertise des Behandlers zu sein.

 

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