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
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2019 (online)

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.

 
  • Literatur

  • 1 GBD Causes of Death Collaborators Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016.. Lancet 2017; 390: 1151-1210
  • 2 The GBD 2016 Lifetime Risk of Stroke Collaborators Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med 2018; 379: 2429-2437
  • 3 Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009; 8: 345-354
  • 4 Centers for Disease Control and Prevention (CDC) Prevalence and most common causes of disability among adults – United States, 2005. MMWR Morb Mortal Wkly Rep 2009; 58: 421-426
  • 5 Kolominsky-Rabas PL, Heuschmann PU, Marschall D. et al. Lifetime Cost of Ischemic Stroke in Germany: Results and National Projections From a Population-Based Stroke Registry. The Erlangen Stroke Project. Stroke 2996 37: 1179-1183
  • 6 Benjamin EJ, Blaha MJ, Chiuve SE. et al. Heart Disease and Stroke Statistics – 2017 Update. Circulation 2017; 135: e146-e603
  • 7 Heuschmann PU, Busse O, Wagner M. et al. Schlaganfallhäufigkeit und Versorgung von Schlaganfallpatienten in Deutschland. Akt neurol 2010; 37: 333-340
  • 8 Madden KP, Karanjia PN, Adams Jr. HP, Clarke WR. Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment. Neurology 1995; 45: 1975-1979
  • 9 Grau AJ, Weimar C, Buggle F. et al. Risk factors outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 2001; 32: 2559-2566
  • 10 De Weerd M, Greving JP, Hedblad B. et al. Prevalence of Asymptomatic Carotid Artery Stenosis in the General Population. An Individual Participant Data Meta-Analysis. Stroke 2010; 41: 1294-7
  • 11 Marschner T. xy Prävalenz von Stenosierungen im extrakraniellen Karotisbereich bei koronarer Herzerkrankun. Dissertationsschrift an der Technischen Universität München 2015
  • 12 Dodick DE, Meissner I, Meyer FB. et al. Evaluation and management of asymptomatic carotid artery stenosis. Mayo Clin Proc 2004; 79: 937-944
  • 13 Barlinn K, Rickmann H, Kitzler H. et al. Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study. Ultraschall in Med 2018; 39: 535-543
  • 14 Barnett HJ, Taylor DW Eliasziw. et al. Benefitof carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339: 1415-1425
  • 15 Nederkoorn PJ, van der Graaf Y, Hunink MG. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 2003; 34: 1324-1332
  • 16 Aboyans V, Ricco J-B, Bartelink M-L EL. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Artery Disease, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur Heart J 2017; 39: 763-786
  • 17 Piepoli MF, Hoes AW, Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37: 2315-2381
  • 18 Paraskevas KI, Spence JD, Veith FJ. et al. Identifying which patients with asymptomatic carotid stenosis could benefit from intervention. Stroke 2014; 45: 3720-3724
  • 19 Nikolaides AN, Kakkos SK, Griffin M. et al. Severity of asymptomatic carotid stenosis and risc of ipsilateral hemispheric ischaemic events: results from the ACSRS study. Eur J Vasc Endovasc Surg 2005; 30: 275-284
  • 20 Kakkos SK, Sabetai M, Tegos T. et al. Silent embolic infarcts on computed tomography brain scansand risk of ipsilateral hemispheric events in patients with asyboli > Studymptomatic internal carotid artery stenosis. J Vasc Surg 2009; 49: 902-909
  • 21 Kakkos SK, Nikolaides AN, Charalambous I. et al. Predictors and clinical significance of progression or regression of asymptomatic carotid artery stenosis. J Vasc Surg 2014; 59: 956-967
  • 22 Markus HS, King A, Shipley M. et al. Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study. Lancet Neurol 2010; 9: 663-671
  • 23 King A, Serena J, Bornstein NM. et al. Does impairedcerebrovascular reactivity predict stroke risk in asymptomatic carotid stenosis? A prospective substudy of the asymptomatic carotid emboli study. Stroke 2011; 42: 1550-1555
  • 24 Gupta A, Chazen JL, Hartman M. et al. Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion: a systematic review and meta-analysis. Stroke 2012; 2884-2891
  • 25 Nicolaides AN, Kakkos SK, Kyriacou E. et al. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. J Vasc Surg 2010; 52: 1486-1496
  • 26 Kakkos SK, Griffin MB, Nikolaides AN. et al. The size of juxtaluminal hypoechoic area in ultrasound images of asymptomatic carotid plaques predicts the occurrence of stroke. J Vasc Surg 2013; 57: 609-618
  • 27 Gupta A, Baradaran H, Schweitzer AD. et al. Carotid plaque MRI and stroke risk: a systematic review and meta-analysis. Stroke 2013; 44: 3071-3077
  • 28 Rothwell PM, Eliasziw M, Gutnikov SA. et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid artery stenosis. Lancet 2003; 36: 107-116
  • 29 Bonati LH, Lyrer P, Ederle J. et al. Percutaneous transluminal balloon angioplastyand stenting for carotid artery stenosi. Cochrane Database Syst Rev 2012; Sep 12 (09) CD000515
  • 30 Bonati LH, Dobson J, Featherstone RL. et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet 2015; 385: 529-538
  • 31 Mas JL, Chatellier G, Beyssen B. et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006; 355: 1660-1671
  • 32 Ederle J, Dobson J, Featherstone RL. et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 2010; 375: 985-997
  • 33 Ringleb PA, Allenberg J, Bruckmann H. et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 2006; 368: 1239-1247
  • 34 Hopkins LN, Roubin GS, Chakhtoura EY. et al. The Carotid Revascularization Endarterectomy versus Stenting Trial: credentialing of interventionalists and final results of lead-in phase. J Stroke Cerebrovasc Dis 2010; 19: 153-162
  • 35 Brott TG, Hobson RW 2nd, Howard G. et al. Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis. N Engl J Med 2010; 363: 11-23
  • 36 Rosenfield K, Matsumura JS, Chaturvedi S. et al. Randomized trial of stent versus surgery for asymptomatioc carotid stenosis. N Engl J Med 2016; 374: 1011-1020
  • 37 Brott TG, Halperin JL, Abbara S. et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery Developed in Collaboration With the American Academy of Neurology and Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2011; 57: e16-94
  • 38 Kernan WN, Ovbiagele B, Black HR. et al. Guidelines for the prevention of stroke in patients withstroke and transient ischemic attack. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160-2236
  • 39 Staubach S, Hein-Rothweiler R, Hochadel M. et al. The role of endovascular expertise in carotid artery stenting: results from the ALKK-CAS-Registry in 5,535 patients. Clin Res Cardiol 2012; 101: 929-937
  • 40 Kumamaru H, Jalbert JJ, Nguyen LL. et al. Surgeon case volume and 30-day mortality after carotid endarterectomy aming contemporary medicare beneficiaries: before and after national coverage determination for carotid artery stenting. Stroke 2015; 46: 1288-1294
  • 41 Hawkins BM, Kennedy KF, Aronow HD. et al. Hospital variation in carotid stenting outcomes. J Am Coll Cardiol Cardiovasc Interv 2015; 6: 858-863
  • 42 Bundesauswertung zum Erfassungsjahr 2017: Karotisrevaskularisation Qualitätsindikatoren IQTIG 2018 https://www.iqtig.org
  • 43 Mudra H, Staubach S, Hein-Rothweiler R. et al. Long-term outcomes of carotid artery stenting in clinical practice. Circ Cardiovasc Interv 2016; 9: e003940
  • 44 Hadar N, Raman G, Moorthy D. et al. Asymptomatic carotid artery stenosis treated with medical therapy alone: temporal trends and implications for risk assessment and the design of future studies. Cerobrovasc Dis 2014; 38: 163-173
  • 45 Schneider PA, Levy E, Bacharach JM. et al. A first in-human evaluation of a novel mesh-coveredstent for treatment of carotid stenosis in patients at high risk for endarterectomy: 30-dayresults of the SCAFFOLD trial. J Am Coll Cardiol Intv 2018; 11: 2396-2404
  • 46 Stabile E, de Donato G, Musialek P. et al. Use of dual-layered stents in endovascular treatment of extracranial stenosis of the internal carotid artery. Results of a patient-based meta-analysis of 4 clinical studies. J Am Coll Cardiol Interv 2018; 11: 2405-2411
  • 47 Mudra H, Ledwoch J. A New Milestone in Carotid Stenting. J Am Coll Cardiol Intv 2018; 2412-2413
  • 48 Langhoff R, Schofer J, Scheinert D. et al. Double filtration during carotid artery stenting using a novel post-dilatation balloon with integrated embolic protection. J Am Coll Cardiol Intv 2019; 12: 395-403
  • 49 Kwolek CJ, Jaff MR, Leal JI. et al. Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. J Vasc Surg 2015; 62: 1227-1235