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Therapieplanung bei gleichzeitigem Vorliegen von koronarer Herzkrankheit und Karotisstenose

Therapeutic concepts for patients with concomitant coronary heart desease and carotid stenosis

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Zusammenfassung

Das kombinierte Auftreten von operationsbedürftiger koronarer Herzkrankheit und hochgradiger Stenose der A. carotis interna wird häufig beobachtet. Die optimale therapeutische Strategie für die betroffenen Patienten wird — hauptsächlich mangels prospektiv randomisierter Studien — kontrovers diskutiert.

Die bislang publizierten Studien präsentieren zum Teil widersprüchliche Ergebnisse, was nicht zuletzt auf die uneinheitliche Indikationsstellung und Patientenselektionierung zurückzuführen ist. In letzter Zeit wurden zu diesem Thema mehrere Metaanalysen publiziert, auf welche in der vorliegenden Übersichtsarbeit näher eingegangen wird. Diese Reviews legen nahe, dass der Einfluss einer Karotispathologie auf das zerebrale Risiko im Rahmen der aortokoronaren Bypassoperation häufig falsch eingeschätzt wird. Das therapeutische Vorgehen muss auf den einzelnen Patienten individuell abgestimmt und von der jeweils vorliegenden Schwere der koronaren Herzkrankheit bzw. der zerebrovaskulären Erkrankung abhängig gemacht werden.

Abstract

Coronary heart disease and high grade carotid stenosis, both requiring operative therapy, commonly occur together. The optimal strategy for affected patients remains controversial, mainly due to a lack of prospective randomised studies.

Reported series present inconsistent results, mainly due to a wide variability in indication and patient selection criteria. This review is mostly based on the results of several meta-analyses that have been published recently. The influence of a carotid stenosis on perioperative cerebral risk is often overestimated. Management decisions have to be made individually and depend on the relative severity of the coronary heart or carotid disease.

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  1. Klinische Abteilung für Gefäßchirurgie, Universitätsklinik Innsbruck

    J. Falkensammer & G. Fraedrich

  2. Abteilung für Chirurgie, Klinische Abteilung für Gefäßchirurgie, Universitätsklinik Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    J. Falkensammer

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Falkensammer, J., Fraedrich, G. Therapieplanung bei gleichzeitigem Vorliegen von koronarer Herzkrankheit und Karotisstenose. Gefässchirurgie 10, 336–340 (2005). https://doi.org/10.1007/s00772-005-0410-7

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  • DOI: https://doi.org/10.1007/s00772-005-0410-7

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