Risikobewertung und Management der Typ-B-Aortendissektion

Die akute Typ-B-Dissektion – ein potenziell lebensbedrohliches Krankheitsbild. Entscheidend für das Outcome der Patienten sind eine schnelle und zielführende, standardisierte Diagnostik zur Klassifikation der Dissektion und Definition der Hochrisikopatienten, um den entsprechenden Behandlungspfad einschlagen zu können.

Kernaussagen

• Die Inzidenz der wirklich unkomplizierten Typ-B-Dissektion ist geringer als bisher vermutet.

• Eine schrittweise Diagnostik zur Bestätigung oder zum Ausschluss von „High-Risk“-Surrogaten sollte anhand einer CT-Angiografie durchgeführt werden, bevor die Diagnose „unkompliziert“ etabliert wird.

• Das Potenzial der Aorta zum positiven Remodeling (Durchmesserabnahme, Approximierung der Wandschichten) nimmt mit der Zeit ab, dies sollte man bei der Wahl des Behandlungszeitpunkts mit einbeziehen („window of opportunity of 90 days“).

• Das Beachten der weitestmöglichen Aufrechterhaltung der Rückenmarkperfusion über die 4 arteriellen Hauptzuflüsse stellt einen entscheidenden Faktor für die Reduktion des Restrisikos für eine symptomatische Rückenmarkischämie dar.

• Die Liquordrainage ist eine hocheffektive Maßnahme zur Vorbeugung und auch zur Therapie symptomatischer Rückenmarksischämien.

• Bei Patienten, die eine Behandlung benötigen, jedoch ein hohes Risiko für eine retrograde Typ-A-Dissektion haben, sollte die FET-Technik in Betracht gezogen werden.

Publikationsverlauf

Artikel online veröffentlicht:
30. November 2021

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