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Kardiologie up2date 2013; 09(02): 133-145
DOI: 10.1055/s-0033-1344191
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© Georg Thieme Verlag KG Stuttgart · New York

Behandlung extrakranieller Karotisstenosen – chirurgisch oder interventionell?

Carola Marie Wieker
,
Serdar Demirel
,
Nicolas Attigah
,
Dittmar Böckler
Further Information

Publication History

Publication Date:
08 July 2013 (online)

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Abstract

About 200.000 people suffer form a ischemic caused stroke per year in germany. 20 % of these are caused by stenosis of the extracranial brain serving vessels, especially the internal carotid artery. Given the clinical severity of the stroke and the socio-economic outcome prevention and therapy of carotid caused strokes is highly relevant. Therapeutic or preventive options are carotid endarterectomy (CEA), carotid artery stenting (CAS) and medical treatment. Among these options the carotid endarterectomy has been proven to be significant superior against the best medical treatment. The CAS procedure is often seen as a rival to the CEA surgery.

Comparing these three options is reasonable and necessary. Therefore this article is aiming to provide a evidence based overview, considering the current data, for a differentiated indication on the therapie of relevant extracranial carotid stenosis.

Kernaussagen

  • Ischämisch bedingte Schlaganfälle gehen in 20 % auf Stenosen der extrakraniellen hirnversorgenden Gefäße, insbesondere der A. carotis interna, zurück. Männer sind häufiger betroffen als Frauen, ältere Patienten häufiger als jüngere.

  • Risikofaktoren einer extrakraniellen Karotisstenose sind Alter, Geschlecht und vaskuläre Faktoren wie z. B. die arterielle Hypertonie.

  • Bei den extrakraniellen Karotisstenosen werden symptomatische und asymptomatische Stenosen unterschieden. Symptomatische Stenosen gehen mit einer höheren perioperativen Schlaganfallrate einher als asymptomatische Stenosen.

  • Die Therapie der Karotisstenose ist als bestmögliche medikamentöse Therapie (BMT), als Karotisendarteriektomie (CEA) oder als Karotis-Stenting (CAS) möglich.

  • Die Indikation zum Karotis-Stenting hängt u. a. von der klinikinternen Komplikationsrate ab. Liegt sie unter 3 %, ist die CAS bei asymptomatischen Stenosen eine Alternative zur CEA. Für die symptomatische Karotisstenose gilt eine Komplikationsrate von < 6 %. Auf Patientenseite sind das Alter, die Aortenbogenkonfiguration, die zu therapierende Seite und die Länge des/der Plaques zu berücksichtigen.

  • Bei symptomatischer Karotisstenose gilt die CEA als Standardbehandlung. Leitlinienkonform kann das CAS für bestimmte Patientensubgruppen komplementär empfohlen werden. Bei asymptomatischen Karotisstenosen ist die Beurteilung schwieriger. Auch hier gilt jedoch die CEA weiter als das Standardverfahren.

 

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