Der Radiologe

, Volume 52, Issue 12, pp 1107–1111

Neueste Studien zu intrakraniellen Stenosen

Leitthema
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Zusammenfassung

Klinisches Problem

Symptomatische intrakranielle arterielle Gefäßstenosen sind mit einem hohen Schlaganfallrisiko behaftet. Durch Thrombozytenaggregationshemmer und Antikoagulation kommt es zu keiner wesentlichen Reduktion dieses Risikos. Alternative Methoden sind deshalb dringend erforderlich.

Neue Therapieverfahren

Das Konzept der perkutanen Therapie etwa mit Ballondilatation oder Stentimplantation erscheint auf den ersten Blick erfolgversprechend, weswegen Stents speziell für die Intervention an zerebralen Gefäßen entwickelt wurden.

Leistungsfähigkeit

Die interventionellen Techniken haben sich bereits frühzeitig in nichtrandomisierten Studien bewährt. In der einzigen randomisierten Studie war die Stentimplantation jedoch mit einem hohen perioperativen Risiko verbunden.

Bewertung und Empfehlung für die Praxis

Die bisherige Studienlage lässt bedingt durch Designdefizite keine definitiven Rückschlüsse hinsichtlich der Effektivität der perkutanen Intervention zur Behandlung symptomatischer intrakranieller Stenosen zu. Deshalb wäre es voreilig, diese Therapiemöglichkeit kategorisch abzulehnen.

Schlüsselwörter

Intrakranielle Stenose Schlaganfall Stentimplantation Ballondilatation Perioperatives Risiko 

Recent studies on intracranial stenosis

Abstract

Clinical issue

Symptomatic intracranial stenoses are associated with a high risk of stroke. Medical management with platelet inhibitors or anticoagulation has not been shown to substantially lower this risk. Hence, alternative treatment options are desperately needed.

Treatment innovations

The concept of percutaneous intervention using balloon angioplasty with or without stenting is appealing at first sight which is why intracranial balloons and stents were developed.

Performance

Initial studies using dedicated intracranial stents were more promising; however, the only randomized trial recently published using a dedicated intracranial self-expanding stent demonstrated a high periprocedural complication rate.

Evaluation and practical recommendations

Due to study design limitations it would be premature to categorically denounce an interventional option for the treatment of symptomatic intracranial stenoses. More importantly, the results of the randomized SAMMPRIS trial should stimulate the development of safer technology and patient selection to minimize procedural risks. This will perhaps allow significant risk reduction of this potentially devastating intracranial condition when it cannot otherwise be addressed.

Keywords

Intracranial stenosis Stroke Stent implantation Balloon angioplasty Perioperative risk 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.NIHR Oxford Biomedical Research Centre, Acute Vascular Imaging Centre Oxford University Hospitals NHS TrustOxfordUK
  2. 2.Veterans Affairs Medical CenterMinneapolisUSA

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