Zusammenfassung
Die Karotisstenose ist eine der wichtigsten Ursachen des ischämischen Schlaganfalls. Die Thrombendarteriektomie (TEA) reduziert das Schlaganfallrisiko bei Patienten mit symptomatischen und symptomfreien Karotisstenosen. Die Stentdilatation stellt eine Alternative zum chirurgischen Eingriff dar, ist jedoch mit einem erhöhten Risiko periprozeduraler Schlaganfälle verbunden. Das Risiko eines periprozeduralen Myokardinfarkts (MI) dagegen wird in den Studien sehr unterschiedlich angegeben. Einige Studien zeigten ein erhöhtes MI-Risiko bei der TEA im Vergleich zur Stentdilatation, während andere Studien keinen solchen Unterschied fanden. Grund dafür sind Unterschiede in den Studienpopulationen sowie in der Definition und Erfassung von MI. Unter Berücksichtigung sämtlicher Daten aus randomisierten Studien ist das periprozedurale MI-Risiko bei der TEA gegenüber der Stentbehandlung erhöht. Periprozedurale MI erhöhen ebenso wie Schlaganfälle die Langzeitmortalität und stellen somit ernst zu nehmende Komplikationen dar. Die Stentdilatation kann deswegen bei Patienten mit erhöhtem koronaren Risiko und klarer Indikation zur Revaskularisation einer Karotisstenose eine Alternative zur TEA darstellen.
Abstract
Carotid stenosis is an important cause of ischaemic stroke. Carotid endarterectomy (CEA) reduces the risk of stroke among patients with symptomatic and asymptomatic carotid stenosis. Stent treatment has emerged as an alternative to surgery but is associated with a higher risk of periprocedural stroke. Randomised trials have yielded conflicting results regarding the risk of myocardial infarction (MI) with stenting and CEA. These differences are mostly explained by differences between trials in study populations, as well as assessment and definition of MI. Considering all available randomised trial data, periprocedural MI is more common with CEA than with stent treatment. As with periprocedural stroke, periprocedural MI also leads to a decrease in long-term survival. Thus, MI must be regarded a serious adverse event complicating carotid interventions. Stent treatment therefore represents an alternative to CEA among patients with clear indication for carotid revascularisation who are considered at increased risk for coronary events.
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Literatur
Weerd M de, Greving JP, Hedblad B et al (2010) Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 41(6):1294–1297
(o A) (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American symptomatic carotid endarterectomy trial collaborators. N Engl J Med 325(7):445–453
(o A) (1998) Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351(9113):1379–1387
(o A) (1995) Endarterectomy for asymptomatic carotid artery stenosis. Executive committee for the asymptomatic carotid atherosclerosis study. JAMA 273(18):1421–1428
Halliday A, Harrison M, Hayter E et al (2010) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 376(9746):1074–1084
Naylor AR, Bolia A, Abbott RJ et al (1998) Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg 28(2):326–334
Alberts MJ (2001) Results of a multicentre prospective randomized trial of carotid artery stenting vs carotid endarterectomy. Stroke 32:325
Ederle J, Bonati LH, Dobson J et al (2009) Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol 8(10):898–907
Brooks WH, McClure RR, Jones MR et al (2001) Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol 38(6):1589–1595
Ling F, Jiao LQ (2006) Preliminary report of trial of endarterectomy versus stenting for the treatment of carotid atherosclerotic stenosis in China (TESCAS-C). Chin J Cerebrovasc Dis 3(1):4–8
Mas JL, Chatellier G, Beyssen B et al (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 355(16):1660–1671
Eckstein HH, Ringleb P, Allenberg JR et al (2008) Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 7(10):893–902
Hoffmann A, Taschner C, Engelter ST et al (2006) Carotid artery stenting versus carotid endarterectomy. A prospective, randomised trial with long termfollow up (BACASS). Schweiz Arch Neurol Psychiatr 157:191
Liu CW, Liu B, Ye W et al (2009) Carotid endarterectomy versus carotid stenting: a prospective randomized trial. Zhonghua Wai Ke Za Zhi 47(4):267–270
Ederle J, Dobson J, Featherstone RL et al (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375(9719):985–997
Brott TG, Hobson RW, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363(1):11–23
Bonati LH, Lyrer P, Ederle J et al (2012) Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev 9:CD000515
Bonati LH, Dobson J, Algra A et al (2010) Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 376(9746):1062–1073
Roffi M, Sievert H, Gray WA et al (2010) Carotid artery stenting versus surgery: adequate comparisons? Lancet Neurol 9(4):339–341
Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351(15):1493–1501
Ringleb PA, Allenberg J, Bruckmann H et al (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368(9543):1239–1247
Blackshear JL, Cutlip DE, Roubin GS et al (2011) Myocardial infarction after carotid stenting and endarterectomy: results from the carotid revascularization endarterectomy versus stenting trial. Circulation 123(22):2571–2578
Steinbauer MG, Pfister K, Greindl M et al (2008) Alert for increased long-term follow-up after carotid artery stenting: results of a prospective, randomized, single-center trial of carotid artery stenting vs carotid endarterectomy. J Vasc Surg 48(1):93–98
Hill MD, Brooks W, Mackey A et al (2012) Stroke after carotid stenting and endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Circulation 126(25):3054–3061
Compliance with Ethic Guidelines
Conflict of Interest. L. Bonati declares that he has no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.
Additional informed consent was obtained from all patients for whom identifying information is included in this article.
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Bonati, L. Myokardiales Risiko bei Karotisendarteriektomie und Stent. Gefässchirurgie 18, 261–266 (2013). https://doi.org/10.1007/s00772-013-1174-0
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DOI: https://doi.org/10.1007/s00772-013-1174-0