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Karotisstenose – Abschätzung des Embolierisikos durch sonographische Plaquemorphologie und Plaquevaskularisation

Carotid stenosis: embolic risk assessment by sonographic plaque morphology and plaque vascularization

  • Vaskuläre Sonographie
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Zusammenfassung

Hintergrund

Das Risiko einer Embolisation, ausgehend von einer Karotisstenose, ist nicht nur abhängig vom Grad der Stenosierung, sondern auch von der Zusammensetzung der entsprechenden arteriosklerotischen Plaque. Insbesondere das Vorliegen von Ulzerationen, die Inflammation, die dünne fibröse Kappe, der große nekrotische Lipidkern sowie die Vaskularisation innerhalb der Plaque, ausgehend von Vasa vasorum und assoziierten Intraplaque-Hämorrhagien, sind Zeichen einer solchen vulnerablen arteriosklerotischen Läsion.

Ziel der Arbeit

Diese Arbeit soll einen Überblick geben aufgrund welcher sonographischer Kriterien der Karotisstenose ein erhöhtes Risiko für einen Schlaganfall abgeschätzt werden kann.

Material und Methode

Duplexsonographisch lässt sich nicht nur aufgrund der Hämodynamik der Stenosegrad festlegen, sondern es lassen sich mittels B‑Bild sonomorphologische Charakteristika einer vulnerablen Plaque und mittels kontrastmittelunterstütztem Ultraschall (CEUS) insbesondere auch eine Plaquevaskularisation beurteilen.

Ergebnisse und Diskussion

Aufgrund der aktuellen Evidenz sind die Hypoechogenität, die Größe der Plaquefläche, die Oberflächenirregularität und eine Ulzeration sowie die Plaquevaskularsiation der Karotisstenose Hinweise auf eine vulnerable Karotisstenose mit erhöhtem Embolierisiko. Diese bildgeberischen Zusatzinformationen sollten uns helfen, diejenigen Patienten mit Karotisstenosen und erhöhtem Embolierisiko zu selektionieren, welche von einer allfälligen invasiven Therapie profitieren könnten.

Abstract

Background

The risk of embolization originating from carotid artery stenosis is dependent not only on the grade of stenosis but also on the composition of the corresponding arteriosclerotic plaque. In particular, the presence of ulcerations, inflammation, a thin fibrous cap, a large necrotic lipid core, in addition to vascularization within the plaque emanating from the vasa vasorum and associated intraplaque hemorrhage, are signs of a vulnerable arteriosclerotic lesion.

Objectives

This article gives an overview based on the sonographic characteristics of carotid stenosis that can be used to estimate the associated increased stroke risk.

Materials and Methods

Duplex ultrasound not only determines the degree of stenosis based on hemodynamic criteria but also makes it possible to assess sonomorphological characteristics of a vulnerable plaque on B‑mode ultrasound, and, in particular, plaque vascularization using contrast-enhanced ultrasound (CEUS).

Results and Conclusions

Based on current evidence, hypoechogenicity, the size of the plaque area, surface irregularities, and ulceration on B‑mode ultrasound, in addition to plaque vascularization of the carotid stenosis on CEUS, are sonographic indications for vulnerable carotid stenosis with increased embolic risk. This additional imaging information should help us to select patients with carotid stenosis and increased embolic risk who may benefit from invasive therapy.

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Authors and Affiliations

  1. Klinik für Angiologie, Universitätsspital Basel, Universität Basel, Petersgraben 4, 4031, Basel, Schweiz

    D. Staub, M. Aschwanden & S. Imfeld

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  1. D. Staub
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  2. M. Aschwanden
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  3. S. Imfeld
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Correspondence to D. Staub.

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Interessenkonflikt

D. Staub, M. Aschwanden und S. Imfeld geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Staub, D., Aschwanden, M. & Imfeld, S. Karotisstenose – Abschätzung des Embolierisikos durch sonographische Plaquemorphologie und Plaquevaskularisation. Gefässchirurgie 25, 84–90 (2020). https://doi.org/10.1007/s00772-019-00597-0

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  • DOI: https://doi.org/10.1007/s00772-019-00597-0

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