Argumente für Operationen an der Arteria carotis

Zusammenfassung

Ziel, Methoden, Patienten: In einer prospektiven, interdisziplinären Studie an 468 operierten Karotisstenosen wurde die Plaquemorphologie, die präoperativ duplexsonographisch untersucht worden war, mit der histologischen Diagnose verglichen. Ergebnisse: Für die Aufdeckung von Soft- und Hardplaques fand sich durch die präoperative Untersuchung eine Sensitivität von ca. 80%. Die Genauigkeit für die Einschätzung des Stenosegrades lag bei 98%. Im Falle eines akuten Schlaganfalls und bei einem Zustand nach Schlaganfall fanden wir Ulzerationen durch die histologischen Untersuchungen von 72%. Mit Ultraschall konnten diese Veränderungen in 53% festgestellt werden. Wir fanden eine signifikant höhere Anzahl an transitorisch-ischämischen Attacken und Schlaganfällen bei Patienten mit Softplaques als im asymptomatischen Stadium, in welchem die Hardplaques öfter gesehen werden. Schlussfolgerungen: Patienten mit einem Softplaque haben ein höheres Risiko, ein postoperatives neurologisches Defizit zu erfahren, insbesondere wenn dieser mit Ulzeration und Thrombosen verbunden ist. Für diese gefährlichen Plaques konnte eine adäquate präoperative Genauigkeit mit keiner Untersuchungsmethode festgestellt werden. Daher ist das Risiko der Embolisation nicht ausreichend vorhersagbar. Für die Indikation zum Stenting wäre dies jedoch sehr wünschenswert, zumal die Anzahl von HITS (high intensity transient signals) beim Stenting 8- bis 20-mal höher ist als bei der Operation.

Summary

Aim, methods, patients: In a prospective interdisciplinary study of 468 carotid artery stenoses we compared the ultrasound plaque morphology with the histological diagnosis. Results: For detection of soft plaques and hard plaques by preoperative ultrasound examination we found a sensitivity of 80%. The accuracy for the estimation of the degree of the stenosis was 98%. In case of stroke in progression and completed stroke we found ulcerations by histological examination in 72%. By ultrasound these ulcerations were detected only in 53%. We found a significant higher figure for TIA and stroke in soft plaque patients than in asymptomatic stage, in which hard plaque formation was seen more often. Consequences: Patients with a soft plaque seem to have a higher risk of a postoperative permanent neurological deficit. However, the dangerous plaque formation with thrombosis or ulceration was not be detected with appropriate accuracy. Therefore the risk of embolisation cannot be predicted sufficiently by means of duplex scanning. This would be extremely important for the indication for stenting in this area. The number of HITS (high intensity transient signals) is 8 to 20 times higher in carotid stenting.

Schlüsselwörter

Karotischirurgie - Plaquemorphologie - Stent - Duplexsonographie

Keywords

Carotid surgery - plaque morphology - stent - duplex sonography

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