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Der Kardiologe

, Volume 12, Issue 6, pp 435–452 | Cite as

Interventionelle Behandlung der Hauptstammstenose

  • O. Dörr
  • H. Möllmann
  • A. Elsässer
  • C. Liebetrau
  • C. W. Hamm
  • H. NefEmail author
CME
  • 584 Downloads

Zusammenfassung

In den aktuellen ESC-Leitlinien werden perkutane Koronarintervention (PCI) und Bypassoperation zur Behandlung von Hauptstammstenosen gleichwertig berücksichtigt. Die PCI ist bei einem SYNTAX-Score von 0–32 Punkten eine sichere Alternative zur Bypassoperation. Bei einem SYNTAX-Score von mehr als 32 Punkten sollte die Bypassoperation bevorzugt werden. Bei der Planung und Durchführung der Hauptstamm-PCI wird der Einsatz der intravaskulären Bildgebung empfohlen. Bei Interventionen des Hauptstamms sollten ausschließlich Drug-eluting-Stents (DES) zur Anwendung kommen, wobei je nach Stenosemorphologie eine Ein- bzw. Zwei-Stent-Strategie in Frage kommt. Zeigt sich nur ein Tochtergefäß betroffen, ist das sog. „provisional stenting“ die bevorzugte Methode. Bei der Wahl der richtigen Zwei-Stent-Stratgie sind die anatomischen Bedingungen (Bifurkationswinkel, Gefäßdiameter) zu berücksichtigen. Gemäß Datenlage ist derzeit die DK-Crush-Technik den anderen Strategien (TAP, Culotte, Mini-Crush) vorzuziehen.

Schlüsselwörter

Bifurkation Hauptstamm-PCI Stenting SYNTAX-Score Intravaskuläre Bildgebung Fraktionelle Flussreserve 

Interventional treatment of unprotected left main coronary artery stenosis

Abstract

In the current ESC guidelines percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are equivalently recommended for the treatment of unprotected left main coronary artery stenosis. PCI is a safe alternative to bypass surgery (CABG) in patients with SYNTAX score <32 points. With SYNTAX scores >32 points CABG should be preferred. In planning and performance of main stem PCI the use of intravascular imaging is recommended. Drug-eluting stents (DES) should exclusively be used for interventions on the main stem, whereby 1 or 2 stent strategies can be used depending on the morphology of the stenosis. If only one daughter vessel is affected, provisional stenting is the method of choice. The choice of the optimal 2‑stent strategy depends on the anatomical conditions (angle of the bifurcation, vessel diameters). According to recently published trials the double kiss (DK) crush technique should currently be preferred over other 2‑stent strategies (TAP, culotte, mini-crush).

Keywords

Bifurcation Main stem PCI Stenting SYNTAX score Intravascular imaging Fractional flow reserve 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

O. Dörr, H. Möllmann, A. Elsässer, C. Liebetrau, C. W. Hamm und H. Nef geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Deutsche Gesellschaft für Kardiologie - Herz- und Kreislaufforschung e.V. Published by Springer Medizin Verlag GmbH, ein Teil von Springer Nature - all rights reserved 2018

Authors and Affiliations

  • O. Dörr
    • 1
  • H. Möllmann
    • 2
  • A. Elsässer
    • 3
  • C. Liebetrau
    • 4
  • C. W. Hamm
    • 1
    • 4
  • H. Nef
    • 1
    • 5
    Email author
  1. 1.Medizinische Klinik I, Abteilung KardiologieUniversitätsklinikum GießenGießenDeutschland
  2. 2.Klinik für Innere Medizin ISt.-Johannes-HospitalDortmundDeutschland
  3. 3.Klinik für KardiologieHerz-Kreislauf-Zentrum OldenburgOldenburgDeutschland
  4. 4.Herz- und ThoraxzentrumCampus Kerckhoff der Universität GießenBad NauheimDeutschland
  5. 5.Abteilung für KardiologieHerz-Kreislauf-ZentrumRotenburg a. d. F.Deutschland

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