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Sprache · Stimme · Gehör 2008; 32(4): 164-175
DOI: 10.1055/s-0028-1090047
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Nicht medikamentöse Prophylaxe des Schlaganfalls[1]

Non-Medical Prevention of StrokeD.  Sander1 , 2 , K.  Sander1 , 2 , T.  Etgen3 , 4
  • 1Neurologische Klinik, Medical Park Bischofswiesen
  • 2Klinikum rechts der Isar der Technischen Universität München
  • 3Klinikum Traunstein
  • 4Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München
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Publication History

Publication Date:
09 December 2008 (online)

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Zusammenfassung

Obwohl in den letzten Jahren wesentliche Fortschritte in der Akutbehandlung des Schlaganfalls zu verzeichnen sind (Thrombolyse, Behandlung auf der Stroke-Unit, optimierte Frührehabilitation) stellt der Schlaganfall nach wie vor die häufigste zu dauerhafter Behinderung führende Erkrankung dar. Von daher kommt der Primärprävention und einer effektiven – an die Ätiopathogenese des Schlaganfalls angepassten – Sekundärprävention eine wesentliche Bedeutung zu. Neben medikamentösen Behandlungsoptionen (Antihypertensiva, Thrombozyten- funktionshemmer, Antikoagulation bei kardialer Emboliequelle, Statine etc.) gibt es auch zahlreiche und evidenzbasierte nichtmedikamentöse Maßnahmen zur Primär- und Sekundärprävention des Schlaganfalls. Im folgenden wird der aktuelle Stand der nichtmedikamentösen Schlaganfallprophylaxe vorgestellt. Dabei wird im ersten Teil auf den Stellenwert von Übergewicht, Nikotin- und Alkoholkonsum, Vitamingabe, körperlicher Aktivität, Schlaf-Apnoe-Syndrom, psychosozialem Stress und Hormontherapie für das Schlaganfallrisiko eingegangen. Im zweiten Teil werden Effektivität und Indikationen zur Sanierung einer symptomatischen bzw. asymptomatischen Karotisstenose – unter besonderer Berücksichtigung der Daten zur Karotis-PTA – dargestellt.

Abstract

Stroke is still the leading cause of long-term major disability in the developed countries, although several improvements have been achieved in acute stroke therapy (e.g., thrombolysis, stroke-unit treatment, optimised early rehabilitation strategies). Therefore, primary prevention as well as an effective secondary prevention – guided by the etiology and risk factors of stroke –is of particular importance to reduce stroke morbidity. In addition to medical prevention strategies (antihypertensives, thrombocyte inhibitors, anticoagulation in atrial fibrillation, statins, etc.), several, including evidenced-based, non-medical options for the primary and secondary prevention of stroke are available. This review summarises the current status of non-medical prevention measures for stroke. In the first part we focus on the importance of obesity, smoking, alcohol, nutrition, vitamin supplementation, physical activity, sleep-apnea syndrome, psychosocial stress and hormone therapy. In the second part we discuss the indications and efficacy of an invasive treatment of symptomatic and asymptomatic carotid stenosis.

Schlüsselwörter

Schlaganfall - Prävention - nichtmedikamentöse Therapie

Key words

stroke - prevention - non-medical treatment

1 Erstveröffentlichung in Akt Neurol 2008; 35: 302–318.

Literatur

  • 1 Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I and II Group. European Action on Secondary Prevention by Intervention to Reduce Events.  Lancet. 2001;  357 995-1001
    CrossrefPubMedGoogle Scholar
  • 2 Khaw K T, Wareham N, Bingham S. et al . Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study.  PLoS Med. 2008;  5 e12
    CrossrefPubMedGoogle Scholar
  • 3 York D A, Rossner S, Caterson I. et al . Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: Group I: worldwide demographics of obesity.  Circulation. 2004;  110 e463-470
    CrossrefPubMedGoogle Scholar
  • 4 Hu G, Tuomilehto J, Silventoinen K. et al . Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke.  Arch Intern Med. 2007;  167 1420-1427
    CrossrefPubMedGoogle Scholar
  • 5 Dagenais G R, Yi Q, Mann J F. et al . Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease.  American heart journal. 2005;  149 54-60
    CrossrefPubMedGoogle Scholar
  • 6 Boden-Albala B, Sacco R L, Lee H S. et al . Metabolic syndrome and ischemic stroke risk: Northern Manhattan Study.  Stroke. 2008;  39 30-35
    CrossrefPubMedGoogle Scholar
  • 7 Bokura H, Yamaguchi S, Iijima K. et al . Metabolic Syndrome Is Associated With Silent Ischemic Brain Lesions.  Stroke. 2008;  39 1607-1609
    CrossrefPubMedGoogle Scholar
  • 8 Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke.  BMJ. 1989;  298 789-794
    CrossrefPubMedGoogle Scholar
  • 9 Kelly T N, Gu D, Chen J. et al .Cigarette Smoking and Risk of Stroke in the Chinese Adult Population. Stroke 2008
    Google Scholar
  • 10 Lawlor D A, Song Y M, Sung J. et al . The association of smoking and cardiovascular disease in a population with low cholesterol levels: a study of 648,346 men from the Korean national health system prospective cohort study.  Stroke. 2008;  39 760-767
    CrossrefPubMedGoogle Scholar
  • 11 Hankey G J, Warlow C P. Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations.  Lancet. 1999;  354 1457-1463
    CrossrefPubMedGoogle Scholar
  • 12 Heuschmann P U, Heidrich J, Wellmann J. et al . Stroke mortality and morbidity attributable to passive smoking in Germany.  Eur J Cardiovasc Prev Rehabil. 2007;  14 793-795
    CrossrefPubMedGoogle Scholar
  • 13 Iribarren C, Darbinian J, Klatsky A L. et al . Cohort study of exposure to environmental tobacco smoke and risk of first ischemic stroke and transient ischemic attack.  Neuroepidemiology. 2004;  23 38-44
    CrossrefPubMedGoogle Scholar
  • 14 Hughes J R, Stead L F, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2003 CD000031
    Google Scholar
  • 15 Silagy C, Lancaster T, Stead L. et al .Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004 CD000146
    Google Scholar
  • 16 Fiore M C. Treating tobacco use and dependence: an introduction to the US Public Health Service Clinical Practice Guideline.  Respir Care. 2000;  45 1196-1199
    PubMedGoogle Scholar
  • 17 Goldstein L B, Adams R, Alberts M J. et al . Primary prevention of ischemic stroke: a guideline from the American Heart Association / American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline.  Stroke. 2006;  37 1583-1633
    CrossrefPubMedGoogle Scholar
  • 18 Reynolds K, Lewis B, Nolen J D. et al . Alcohol consumption and risk of stroke: a meta-analysis.  JAMA. 2003;  289 579-588
    CrossrefPubMedGoogle Scholar
  • 19 Mukamal K J, Ascherio A, Mittleman M A. et al . Alcohol and risk for ischemic stroke in men: the role of drinking patterns and usual beverage.  Annals of internal medicine. 2005;  142 11-19
    PubMedGoogle Scholar
  • 20 He K, Rimm E B, Merchant A. et al . Fish consumption and risk of stroke in men.  JAMA. 2002;  288 3130-3136
    CrossrefPubMedGoogle Scholar
  • 21 Mozaffarian D, Longstreth Jr W T, Lemaitre R N. et al . Fish consumption and stroke risk in elderly individuals: the cardiovascular health study.  Arch Intern Med. 2005;  165 200-206
    CrossrefPubMedGoogle Scholar
  • 22 Myint P K, Welch A A, Bingham S A. et al . Habitual fish consumption and risk of incident stroke: the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study.  Public health nutrition. 2006;  9 882-888
    PubMedGoogle Scholar
  • 23 Arnlov J, Vessby B, Riserus U. Coffee consumption and insulin sensitivity.  JAMA. 2004;  291 1199-1201
    CrossrefPubMedGoogle Scholar
  • 24 Lopez-Garcia E, van Dam R M, Qi L. et al . Coffee consumption and markers of inflammation and endothelial dysfunction in healthy and diabetic women.  The American journal of clinical nutrition. 2006;  84 888-893
    PubMedGoogle Scholar
  • 25 Leys D, Deplanque D, Mounier-Vehier C. et al . Stroke prevention: management of modifiable vascular risk factors.  J Neurol. 2002;  249 507-517
    CrossrefPubMedGoogle Scholar
  • 26 Mozaffarian D, Fried L P, Burke G L. et al . Lifestyles of older adults: can we influence cardiovascular risk in older adults?.  Am J Geriatr Cardiol. 2004;  13 153-160
    CrossrefPubMedGoogle Scholar
  • 27 Larsson S C, Mannisto S, Virtanen M J. et al .Coffee and Tea Consumption and Risk of Stroke Subtypes in Male Smokers. Stroke 2008
    Google Scholar
  • 28 Larsson S C, Virtanen M J, Mars M. et al . Magnesium, calcium, potassium, and sodium intakes and risk of stroke in male smokers.  Arch Intern Med. 2008;  168 459-465
    CrossrefPubMedGoogle Scholar
  • 29 Dauchet L, Amouyel P, Dallongeville J. Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies.  Neurology. 2005;  65 1193-1197
    CrossrefPubMedGoogle Scholar
  • 30 Mellen P B, Walsh T F, Herrington D M. Whole grain intake and cardiovascular disease: a meta-analysis.  Nutr Metab Cardiovasc Dis. 2008;  18 283-290
    CrossrefPubMedGoogle Scholar
  • 31 Cook N R, Cutler J A, Obarzanek E. et al . Long-term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP).  BMJ. 2007;  334 885
    CrossrefPubMedGoogle Scholar
  • 32 Fung T T, Chiuve S E, McCullough M L. et al . Adherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women.  Arch Intern Med. 2008;  168 713-720
    CrossrefPubMedGoogle Scholar
  • 33 Voko Z, Hollander M, Hofman A. et al . Dietary antioxidants and the risk of ischemic stroke: the Rotterdam Study.  Neurology. 2003;  61 1273-1275
    PubMedGoogle Scholar
  • 34 Larsson S C, Mannisto S, Virtanen M J. et al . Folate, Vitamin B6, Vitamin B12, and Methionine Intakes and Risk of Stroke Subtypes in Male Smokers.  Am J Epidemiol. 2008;  167 954-961
    CrossrefPubMedGoogle Scholar
  • 35 Vivekananthan D P, Penn M S, Sapp S K. et al . Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials.  Lancet. 2003;  361 2017-2023
    CrossrefPubMedGoogle Scholar
  • 36 Bonaa K H, Njolstad I, Ueland P M. et al . Homocysteine lowering and cardiovascular events after acute myocardial infarction.  N Engl J Med. 2006;  354 1578-1588
    CrossrefPubMedGoogle Scholar
  • 37 Lonn E, Yusuf S, Arnold M J. et al . Homocysteine lowering with folic acid and B vitamins in vascular disease.  N Engl J Med. 2006;  354 1567-1577
    Google Scholar
  • 38 Wang X, Qin X, Demirtas H. et al . Efficacy of folic acid supplementation in stroke prevention: a meta-analysis.  Lancet. 2007;  369 1876-1882
    CrossrefPubMedGoogle Scholar
  • 39 Sander D, Poppert H, Sander K. Nichtmedikamentöse Prophylaxe des Schlaganfalls.  Akt Neurol. 2006;  33 403-411
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Lee C D, Folsom A R, Blair S N. Physical activity and stroke risk: a meta-analysis.  Stroke. 2003;  34 2475-2481
    CrossrefPubMedGoogle Scholar
  • 41 Wendel-Vos G C, Schuit A J, Feskens E J. et al . Physical activity and stroke. A meta-analysis of observational data.  Int J Epidemiol. 2004;  33 787-798
    CrossrefPubMedGoogle Scholar
  • 42 Yaggi H K, Concato J, Kernan W N. et al . Obstructive sleep apnea as a risk factor for stroke and death.  N Engl J Med. 2005;  353 2034-2041
    CrossrefPubMedGoogle Scholar
  • 43 Munoz R, Duran-Cantolla J, Martinez-Vila E. et al . Severe sleep apnea and risk of ischemic stroke in the elderly.  Stroke. 2006;  37 2317-2321
    CrossrefPubMedGoogle Scholar
  • 44 Sahlin C, Sandberg O, Gustafson Y. et al . Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up.  Arch Intern Med. 2008;  168 297-301
    CrossrefPubMedGoogle Scholar
  • 45 Giles T L, Lasserson T J, Smith B J. et al .Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006 CD001106
    Google Scholar
  • 46 Marin J M, Carrizo S J, Vicente E. et al . Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.  Lancet. 2005;  365 1046-1053
    CrossrefPubMedGoogle Scholar
  • 47 Salaycik K J, Kelly-Hayes M, Beiser A. et al . Depressive symptoms and risk of stroke: the Framingham Study.  Stroke. 2007;  38 16-21
    CrossrefPubMedGoogle Scholar
  • 48 Bos M J, Linden T, Koudstaal P J. et al . Depressive Symptoms and Risk of Stroke: The Rotterdam Study.  J Neurol Neurosurg Psychiatry. 2008;  , doi DOI: 10.1136/jnnp.2007.134965
    PubMedGoogle Scholar
  • 49 Surtees P G, Wainwright N W, Luben R N. et al . Psychological distress, major depressive disorder, and risk of stroke.  Neurology. 2008;  70 788-794
    CrossrefPubMedGoogle Scholar
  • 50 Rossouw J E, Anderson G L, Prentice R L. et al . Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial.  JAMA. 2002;  288 321-333
    CrossrefPubMedGoogle Scholar
  • 51 Viscoli C M, Brass L M, Kernan W N. et al . A clinical trial of estrogen-replacement therapy after ischemic stroke.  N Engl J Med. 2001;  345 1243-1249
    CrossrefPubMedGoogle Scholar
  • 52 Simon J A, Hsia J, Cauley J A. et al . Postmenopausal hormone therapy and risk of stroke: The Heart and Estrogen-progestin Replacement Study (HERS).  Circulation. 2001;  103 638-642
    CrossrefPubMedGoogle Scholar
  • 53 Rijbroek A, Wisselink W, Vriens E M. et al . Asymptomatic carotid artery stenosis: past, present and future. How to improve patient selection?.  Eur Neurol. 2006;  56 139-154
    CrossrefPubMedGoogle Scholar
  • 54 Inzitari D, Eliasziw M, Gates P. et al . The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med. 2000;  342 1693-1700
    CrossrefPubMedGoogle Scholar
  • 55 Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).  Lancet. 1998;  351 1379-1387
    CrossrefPubMedGoogle Scholar
  • 56 Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.  N Engl J Med. 1991;  325 445-453
    CrossrefPubMedGoogle Scholar
  • 57 Baker W H, Howard V J, Howard G. et al . Effect of contralateral occlusion on long-term efficacy of endarterectomy in the asymptomatic carotid atherosclerosis study (ACAS). ACAS Investigators.  Stroke. 2000;  31 2330-2334
    CrossrefPubMedGoogle Scholar
  • 58 Wardlaw J. Carotid imaging for secondary stroke prevention in routine practice.  International Journal of Stroke. 2008;  3 20-32
    CrossrefPubMedGoogle Scholar
  • 59 Wardlaw J M, Chappell F M, Best J J. et al . Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis.  Lancet. 2006;  367 1503-1512
    CrossrefPubMedGoogle Scholar
  • 60 Back M R, Rogers G A, Wilson J S. et al . Magnetic resonance angiography minimizes need for arteriography after inadequate carotid duplex ultrasound scanning.  J Vasc Surg. 2003;  38 422-430; discussion 431
    CrossrefPubMedGoogle Scholar
  • 61 Mathiesen E B, Bonaa K H, Joakimsen O. Echolucent plaques are associated with high risk of ischemic cerebrovascular events in carotid stenosis: the tromso study.  Circulation. 2001;  103 2171-2175
    CrossrefPubMedGoogle Scholar
  • 62 Esposito L, Sievers M, Sander D. et al . Detection of unstable carotid artery stenosis using MRI.  J Neurol. 2007;  254 1714-1722
    CrossrefPubMedGoogle Scholar
  • 63 Wasserman B A, Wityk R J, Trout 3rd H H, Virmani R. Low-grade carotid stenosis: looking beyond the lumen with MRI.  Stroke. 2005;  36 2504-2513
    CrossrefPubMedGoogle Scholar
  • 64 Takaya N, Yuan C, Chu B. et al . Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI – initial results.  Stroke. 2006;  37 818-823
    CrossrefPubMedGoogle Scholar
  • 65 Hellings W E, Moll F L, de Vries J P. et al . Atherosclerotic plaque composition and occurrence of restenosis after carotid endarterectomy.  JAMA. 2008;  299 547-554
    CrossrefPubMedGoogle Scholar
  • 66 Naylor A R, Rothwell P M, Bell P R. Overview of the principal results and secondary analyses from the European and North American randomised trials of endarterectomy for symptomatic carotid stenosis.  Eur J Vasc Endovasc Surg. 2003;  26 115-129
    CrossrefPubMedGoogle Scholar
  • 67 Barnett H J, Taylor D W, Eliasziw M. et al . Benefit of 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
    CrossrefPubMedGoogle Scholar
  • 68 Rothwell P M, Eliasziw M, Gutnikov S A. et al . Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.  Lancet. 2004;  363 915-924
    CrossrefPubMedGoogle Scholar
  • 69 Rothwell P M, Eliasziw M, Gutnikov S A. et al . Sex difference in the effect of time from symptoms to surgery on benefit from carotid endarterectomy for transient ischemic attack and nondisabling stroke.  Stroke. 2004;  35 2855-2861
    CrossrefPubMedGoogle Scholar
  • 70 Alamowitch S, Eliasziw M, Barnett H J. The risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease.  Stroke. 2005;  36 27-31
    CrossrefPubMedGoogle Scholar
  • 71 Dodick D W, Meissner I, Meyer F B. et al . Evaluation and management of asymptomatic carotid artery stenosis.  Mayo Clin Proc. 2004;  79 937-944
    CrossrefPubMedGoogle Scholar
  • 72 Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.  JAMA. 1995;  273 1421-1428
    CrossrefPubMedGoogle Scholar
  • 73 Halliday A, Mansfield A, Marro J. et al . Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial.  Lancet. 2004;  363 1491-1502
    CrossrefPubMedGoogle Scholar
  • 74 Moore W S, Vescera C L, Robertson J T. et al . Selection process for surgeons in the Asymptomatic Carotid Atherosclerosis Study.  Stroke. 1991;  22 1353-1357
    CrossrefPubMedGoogle Scholar
  • 75 Bond R, Rerkasem K, Shearman C P. et al . Time trends in the published risks of stroke and death due to endarterectomy for symptomatic carotid stenosis.  Cerebrovasc Dis. 2004;  18 37-46
    CrossrefPubMedGoogle Scholar
  • 76 Rothwell P M. ACST: which subgroups will benefit most from carotid endarterectomy?.  Lancet. 2004;  364 1122-1123; author reply 1125–1126
    CrossrefPubMedGoogle Scholar
  • 77 Chaturvedi S, Bruno A, Feasby T. et al . Carotid endarterectomy – an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology. 2005;  65 794-801
    CrossrefPubMedGoogle Scholar
  • 78 Sabeti S, Schlager O, Exner M. et al . Progression of carotid stenosis detected by duplex ultrasonography predicts adverse outcomes in cardiovascular high-risk patients.  Stroke. 2007;  38 2887-2894
    CrossrefPubMedGoogle Scholar
  • 79 Yadav J S, Wholey M H, Kuntz R E. et al . Protected carotid-artery stenting versus endarterectomy in high-risk patients.  N Engl J Med. 2004;  351 1493-1501
    CrossrefPubMedGoogle Scholar
  • 80 Fayad P. Endarterectomy and stenting for asymptomatic carotid stenosis: a race at breakneck speed.  Stroke. 2007;  38 707-714
    CrossrefPubMedGoogle Scholar
  • 81 Gurm H S, Yadav J S, Fayad P. et al . Long-term results of carotid stenting versus endarterectomy in high-risk patients.  N Engl J Med. 2008;  358 1572-1579
    CrossrefPubMedGoogle Scholar
  • 82 Ringleb P A, 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
    CrossrefPubMedGoogle Scholar
  • 83 Mas J L, Chatellier G, Beyssen B. et al . Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.  N Engl J Med. 2006;  355 1660-1671
    CrossrefPubMedGoogle Scholar
  • 84 Kern R, Ringleb P A, Hacke W. et al . Stenting for carotid artery stenosis.  Nat Clin Pract Neurol. 2007;  3 212-220
    PubMedGoogle Scholar
  • 85 Stingele R, Berger J, Alfke K. et al . Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study.  Lancet neurology. 2008;  7 216-222
    CrossrefPubMedGoogle Scholar
  • 86 Bates E R, Babb J D, Casey Jr D E. et al . ACCF / SCAI / SVMB / SIR / ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF / SCAI / SVMB / SIR / ASITN Clinical Expert Consensus Document Committee on Carotid Stenting).  J Am Coll Cardiol. 2007;  49 126-170
    CrossrefPubMedGoogle Scholar

1 Erstveröffentlichung in Akt Neurol 2008; 35: 302–318.

Prof. Dr. Dirk Sander

Neurologische Klinik, Medical Park Loipl

Thanngasse 15

83483 Bischofswiesen

Email: D.Sander@mac.com

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