Gefässchirurgie

, Volume 18, Issue 4, pp 261–266 | Cite as

Myokardiales Risiko bei Karotisendarteriektomie und Stent

Leitthema
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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.

Schlüsselwörter

Karotisstenose Stent Thrombendarteriektomie Myokardinfarkt Schlaganfall 

Myocardial risk in carotid endarterectomy and stenting

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.

Keywords

Carotid stenosis Stent Endarterectomy Myocardial infarction Stroke 

Notes

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Neurologische Klinik und PoliklinikUniversitässpital BaselBaselSchweiz

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