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Zerebrale Protektion bei endovaskulären Prozeduren

Cerebral protection in endovascular procedures

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Einführung der Transkatheter-Aortenklappenimplantation in die klinische Praxis hat die Behandlung älterer und Hochrisikopatienten mit Aortenklappenstenose revolutioniert. Die Ausweitung der Indikation auf Patienten mit niedrigerem operativen Risiko wird viel diskutiert – jedoch u. a. wegen der potenziellen neurologischen Komplikationen kritisch betrachtet. Vor allem die hohe Inzidenz an subklinischen Infarkten ist in diesem Zusammenhang kritisch. Die Anwendung perkutan implantierbarer, zerebraler Protektionssysteme als „Filter“ oder „Deflektoren“ hat in ersten klinischen Studien vielversprechende Ergebnisse gezeigt. Größere Studien und Metaanalysen konnten eine Verringerung der Gesamthäufigkeit zerebraler Ischämien jedoch nicht bestätigen. Diese ergaben lediglich eine signifikante Reduktion der Läsionsvolumina und somit eine geringere Häufigkeit an neurokognitiven Symptomen. Gleichzeitig waren Verlängerungen der Prozedurdauer und der Durchleuchtungszeiten beobachtet worden. Die tatsächliche Rolle zerebraler Protektionssysteme in der klinischen Routine wird sich mit wachsender Evidenz wohl zukünftig erst definieren.

Abstract

The introduction of transcatheter aortic valve implantation into clinical practice has revolutionized the treatment of elderly and high-risk patients with aortic valve stenosis; however, extension of the indications to patients at lower operative risk is, among other factors, limited due to neurological complications seen after these procedures. Besides manifest ischemic stroke, subclinical cerebral lesions are problematic as they are frequent and can lead to neurocognitive impairment. The development and use of percutaneously implantable cerebral protection devices, so-called filter or deflection devices, has shown promising results in improving neurological outcomes in initial clinical studies. Larger studies and meta-analyses, however, revealed that the overall rate of ischemic stroke is actually not reduced and merely the overall lesion volume could be significantly reduced leading to a lower frequency of neurocognitive impairment. On the other hand, longer procedural and fluoroscopy times were noted. The definitive role of cerebral protection devices in the clinical routine is still to be determined, based on growing evidence.

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Herzchirurgie, Mitteldeutsches Herzzentrum, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    M. Silaschi &  H. Treede

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  1. M. Silaschi
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Correspondence to M. Silaschi.

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M. Silaschi und H. Treede geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Silaschi, M., Treede, H. Zerebrale Protektion bei endovaskulären Prozeduren. Z Herz- Thorax- Gefäßchir 31, 303–307 (2017). https://doi.org/10.1007/s00398-017-0141-6

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  • DOI: https://doi.org/10.1007/s00398-017-0141-6

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