Zusammenfassung
Stenosen der extrakraniellen A. carotis sind eine behandelbare Ursache von Schlaganfällen. Sie können mithilfe des vaskulären Ultraschalls sicher detektiert und graduiert werden. Die Therapie richtet sich nach der Differenzierung zwischen symptomatischer und asymptomatischer Stenose, dem Operationsrisiko und der Lebenserwartung des Patienten. Die Basis bilden eine optimale Therapie der kardiovaskulären Risikofaktoren und eine Thrombozytenfunktionshemmung. Die Revaskularisation durch eine operative Karotisendarteriektomie ist ein effektives Verfahren zur Verhinderung von Schlaganfällen bei Patienten mit hochgradiger symptomatischer Stenose. In Zentren mit niedriger Komplikationsrate ist die endovaskuläre Therapie mittels der stentgestützten perkutanen transluminalen Angioplastie (PTA) der A. carotis interna eine Alternative bei Patienten mit hohem Operationsrisiko. Bei asymptomatischer Karotisstenose steht die konservative Therapie im Vordergrund, eine Revaskularisation ist bei Patienten mit niedrigem Operations- und globalem kardiovaskulärem Risiko indiziert.
Abstract
Stenosis of the extracranial carotid artery is a treatable cause of ischemic stroke and can reliably be detected and graded by vascular ultrasound. The differentiation between symptomatic and asymptomatic stenosis, the perioperative risk and the estimated life expectancy of the patient guide the therapy. Therapy is based on an optimal treatment of cardiovascular risk factors and antiplatelet drugs. Revascularization using surgical carotid endarterectomy is efficient for the prevention of stroke in patients with a high grade symptomatic stenosis. Endovascular therapy using stent-protected angioplasty of the carotid artery is an alternative in patients with a higher surgical risk with low complication rates when performed in experienced centres. Patients with asymptomatic carotid artery stenosis are primarily treated conservatively and revascularization is indicated in patients with a low surgical and global cardiovascular risk.
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Halbritter, K., Weiss, N. Update Karotisstenose. Internist 54, 715–725 (2013). https://doi.org/10.1007/s00108-013-3277-9
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DOI: https://doi.org/10.1007/s00108-013-3277-9
Schlüsselwörter
- Ischämischer Schlaganfall
- Karotisendarteriektomie
- Stentgestützte Angioplastie
- Optimale medikamentöse Therapie
- Vaskulärer Ultraschall