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Der Chirurg

, Volume 78, Issue 11, pp 1041–1048 | Cite as

Stellenwert der Revaskularisation eines akuten Karotisverschlusses

  • B.T. Weis-Müller
  • R. Huber
  • A. Spivak-Dats
  • B. Turowski
  • R. Seitz
  • M. Siebler
  • W. Sandmann
Originalien

Zusammenfassung

Fragestellung

Untersucht wurde der gegenwärtige Stellenwert der Revaskularisation eines akuten Karotisverschluss im akuten Insult.

Methoden

Von 1997–2006 wurden innerhalb einer kontinuierlichen Serie 34 Patienten mit einem akuten Karotisverschluss prospektiv erfasst, die wir innerhalb von 72 h (Durchschnitt 25 h) nach Symptombeginn und innerhalb von 36 h (Durchschnitt 16 h) nach stationärer Aufnahme notfallmäßig revaskularisiert haben. Einschlusskriterium war der frische extrakraniellen A.-carotis-interna (ACI)-Verschluss im akuten ischämischen Insult. Ausschlusskriterien waren ein Verschluss der intrakraniellen ACI oder der A. cerebri media, ein Insult von mehr als einem Drittel des Mediastromgebietes oder eine eingeschränkte Bewusstseinslage. Alle Patienten erhielten präoperativ ein Doppler-/Duplexuntersuchung und eine Angiographie, ein zerebrales Computer- und/oder ein Magnetresonanztomogramm. Die Bifurkationsgefäße wurden thrombendarteriektomiert und die distal davon gelegene Thrombose entfernt.

Ergebnisse

Zwei Patienten (6%) erlitten eine intrakranielle Blutung und ein Patient (3%) einen Reinfarkt. Zum Zeitpunkt der Entlassung waren 30 (88%) der 34 Karotisverschlüsse erfolgreich revaskularisiert, 59% der Patienten (n=20) hatten sich neurologisch verbessert, 29% (n=10) waren stabil, 6% (n=2) hatten sich verschlechtert. Die 30-Tage-Letalität betrug 6% (n=2).

Schlussfolgerung

Nach sorgfältiger präoperativer Abklärung ist es möglich, einen akuten Karotisverschluss im ischämischen Insult mit relativ geringer Morbidität und Mortalität zu rekanalisieren.

Schlüsselwörter

A. carotis interna Akuter Karotisverschluss Akute Karotischirurgie Ischämischer Insult 

Indication for emergent revascularisation of acute carotid occlusion

Abstract

Background and Purpose

We examined indications for emergent revascularisation of acutely occluded internal carotid artery (ICA) using current diagnostic methods.

Material and Methods

From 1997 to 2006 we prospectively followed 34 consecutive patients undergoing emergency revascularisation due to acute extracranial ICA occlusion and acute ischaemic stroke within 72 h after symptom onset (mean 25) and within 36 h after admission (mean 16). Exclusion criteria were occlusion of the intracranial ICA or ipsilateral middle cerebral artery (MCA), ischaemic infarction of more than one third of the MCA perfusion area, or reduced level of consciousness. All patients underwent duplex sonography, cerebral CT, and/or MRI and angiography (MRA and/or DSA). We performed endarterectomy and thrombectomy of the ICA.

Results

Confirmed by postoperative duplex sonography at discharge, ICA revascularisation was successful in 30 (88%) of 34 cases. Postoperative intracranial haemorrhage was detected in two patients (6%) and perioperative reinfarction in one (3%). Compared to the preoperative status, 20 patients (59%) showed signs of clinical improvement by at least one point on the Rankin scale, ten patients (29%) remained stable, and two patients (6%) had deteriorated. The 30-day mortality was 6% (two patients).

Conclusion

After careful diagnostic workup, revascularisation of acute extracranial ICA occlusion is feasible with low morbidity and mortality.

Keywords

Internal carotid artery Acute occlusion Acute stroke Revascularisation 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • B.T. Weis-Müller
    • 1
  • R. Huber
    • 1
  • A. Spivak-Dats
    • 1
  • B. Turowski
    • 2
  • R. Seitz
    • 3
  • M. Siebler
    • 3
  • W. Sandmann
    • 1
  1. 1.Klinik für Gefäßchirurgie und NierentransplantationUniklinikum der Heinrich-Heine-UniversitätDüsseldorfDeutschland
  2. 2.Klinik für RadiologieUniversitätsklinikum der Heinrich-Heine-UniversitätDüsseldorfDeutschland
  3. 3.Klinik für NeurologieUniversitätsklinikum der Heinrich-Heine-UniversitätDüsseldorfDeutschland

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