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Technik der Karotis-PTA

Carotid artery stenting technique

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Zusammenfassung

Die Stentbehandlung von Stenosen der A. carotis (CAS) ist zu einer Alternative für die Karotisendatherektomie (CEA) herangereift. Vor allem jüngere Patienten und symptomatische Patienten mit einer kontralateralen Okklusion der A. carotis profitieren von einer CAS-Prozedur. Die Auswahl des geeigneten Patienten, ausreichende Erfahrung mit verschiedenen Techniken der Prozedur sowie die Kenntnis der Strategien zur Vermeidung und Beherrschung von Komplikationen sind unabdingbare Voraussetzung für eine erfolgreiche Prozedur. In Zentren mit großer Erfahrung liegt die periprozedurale Komplikationsrate heutzutage mit 2–3% deutlich unter der in randomisierten Studien berichteten. Mit fachgerechter Anwendung der verschiedenen zur Verfügung stehenden Devices lässt sich die Prozedur auf den individuellen Patienten zuschneiden. Komplikationen wie Hyperperfusion und intrazerebrale Blutung, Ruptur von Seitenästen der A. carotis externa oder der A. carotis interna sowie Probleme, die durch „slow flow“ entstehen, lassen sich mit ausreichender Erfahrung weitgehend vermeiden.

Abstract

Over the past 25 years carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA). Most of all younger patients and symptomatic patients with contralateral carotid artery occlusion particularly benefit from CAS. To achieve an optimal result with CAS, patient selection and even more important, knowledge and experience of the interventionist is crucial. The periprocedural complication rate of CAS in large experienced centers is lower (2–3%) than those in randomized trials. Several different devices are now available which allow the procedure to be tailored according to patient anatomy and lesion complexity. Complications like hyperperfusion syndrome and intracerebral bleeding, rupture of side branches of the external or internal carotid artery as well as problems caused by slow flow can be widely avoided by adequate experience.

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Literatur

  1. Weerd M de, Greving JP, Jong AW de et al (2009) Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke 40:1105–1113

    Article  PubMed  Google Scholar 

  2. Capoccia L, Sbarigia E, Rizzo A et al (2012) Silent stroke and cognitive decline in asymptomatic carotid stenosis revascularization. Vascular 20:181–187

    Article  PubMed  Google Scholar 

  3. European Stroke Organisation, Tendera M, Aboyans V et al (2011) ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 32:2851–2906

    Article  Google Scholar 

  4. Gattuso R, Martinelli O, Alunno A et al (2010) Carotid stenting and transcranial Doppler monitoring: indications for carotid stenosis treatment. Vasc Endovascular Surg 44:535–538

    Article  PubMed  Google Scholar 

  5. Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501

    Article  PubMed  CAS  Google Scholar 

  6. Mas JL, Trinquart L, Leys D et al (2008) Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 7:885–892

    Article  PubMed  Google Scholar 

  7. SPACE Collaborative Group, Ringleb PA, Allenberg J et al (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368:1239–1247

    Article  Google Scholar 

  8. International Carotid Stenting Study Investigators, Ederle J, Dobson J et al (2010) Carotid-artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomized controlled trial. Lancet 375:985–997

    Article  Google Scholar 

  9. Liu ZJ, Fu WG, Cuo ZY et al (2012) Updated systematic review and meta-analysis of randomized clinical trials comparing carotid artery stenting and carotid endatherectomy in the treatment of carotid stenosis. Ann Vasc Surg 26:576–590

    Article  PubMed  Google Scholar 

  10. Roffi M, Mukherjee D, Clair DG (2009) Carotid artery stenting vs. endarterectomy. Eur Heart J 30:2693–2704

    Article  PubMed  Google Scholar 

  11. Brott TG, Hobson RW, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23

    Article  PubMed  CAS  Google Scholar 

  12. Kastrup A, Göschel K (2007) Caroitd endarterectomy versus carotid stenting: an updated review of randomized trials and subgroup analyses. Acta Chir Belg 107:119–128

    PubMed  CAS  Google Scholar 

  13. Bijuklic K, Tübler T, Wandler A et al (2011) Carotid artery stenting, what can be learned after more than 1,000 patients: a single centre single operator experience. EuroIntervention 7:820–827

    Article  PubMed  Google Scholar 

  14. Staubach S, Hein-Rothweiler R, Hochadel M et al (2012) The role of endovascular expertise in carotid artery stenting: results from the ALKK-CAS-Registry in 5,535 patients. Clin Res Cardiol 101:929–937

    Article  PubMed  Google Scholar 

  15. Verzini F, Cao P, De Rango P et al (2006) Appropriateness of learning curve for carotid artery stenting: an analysis of periprocedural complications. J Vasc Surg 44:1205–1212

    Article  PubMed  Google Scholar 

  16. Lin PH, Bush RL, Peden E et al (2005) What is the learning curve for carotid artery stenting with neuroprotection? Analysis of 200 consecutive cases at an academic institution. Perspect Vasc Surg Endovasc Ther 17:123–125

    Google Scholar 

  17. Clair DG, Hopkins LN, Mehta M et al (2011) Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30-day outcomes in the EMPiRE Clinical Study. Catheter Cardiovasc Interv 77:420–429

    Article  PubMed  Google Scholar 

  18. Nikas DN, Torsello G, Reimers B (2013) Proximal occlusion system. Minerva Cardioangiol 61:135–144

    PubMed  CAS  Google Scholar 

  19. Montorsi P, Galli S, Ravagnani P et al (2010) Randomized trial of predilation versus direct stenting for treatment of carotid artery stenosis. Int J Cardiol 138:233–238

    Article  PubMed  Google Scholar 

  20. Bosiers M, Donato G de, Deloose K et al (2007) Does free cell area influence the outcome in carotid artery stenting? Eur J Vasc Endovasc Surg 33:135–143

    Article  PubMed  CAS  Google Scholar 

  21. Timaran CH, Rosero EB, Higuera A et al (2011) Randomized clinical trial of open-cell vs closed-cell stents for carotid stenting and effects of stent design on cerebral embolization. J Vasc Surg 54:1310–1316

    Article  PubMed  Google Scholar 

  22. Vos JA, Berg JC van den, Ernst SM et al (2005) Carotid angioplasty and stent placement: comparison of transcranial Doppler US data and clinical outcome with and without filtering cerebral protection devices in 509 patients. Radiology 2:493–499

    Article  Google Scholar 

  23. Jaeger H, Mathias K, Drescher R et al (2001) Clinical results of cerebral protection with a filter device during stent implantation of the carotid artery. Cardiovasc Intervent Radiol 24:249–256

    Article  PubMed  CAS  Google Scholar 

  24. Parodi JC, La Mura R, Ferreira LM et al (2000) Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg 32:1127–1136

    Article  PubMed  CAS  Google Scholar 

  25. Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501

    Article  PubMed  CAS  Google Scholar 

  26. Kastrup A, Nägele T, Gröschel K et al (2006) Incidence of new brain lesions after carotid stenting with and without cerebral protection. Stroke 37:2312–2316

    Article  PubMed  Google Scholar 

  27. Mas JL, Chatellier G, Beyssen B; EVA-3S Investigators (2004) Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) trial. Stroke 35:e18–e20

    PubMed  CAS  Google Scholar 

  28. Jansen O, Fiehler J, Hartmann M, Brückmann H (2009) Protection or nonprotection in carotid stent angioplasty: the influence of interventional techniques on outcome data from the SPACE Trial. Stroke 40:841–846

    Article  PubMed  Google Scholar 

  29. Ansel GM, Hopkins LN, Jaff MR et al (2010) Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv 76:1–8

    Article  PubMed  Google Scholar 

  30. Stabile E, Salemme L, Sorropago G et al (2010) Proximal endovascular occlusion for carotid artery stenting: results from a prospective registry of 1,300 patients. J Am Coll Cardiol 55:1661–1667

    Article  PubMed  Google Scholar 

  31. Clair DG, Hopkins LN, Mehta M et al (2011) Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30-day outcomes in the EMPiRE clinical study. Catheter Cardiovasc Interv 77:420–429

    Article  PubMed  Google Scholar 

  32. Nikas D, Reith W, Schmidt A et al (2012) Prospective, multicenter European study of the GORE flow reversal system for providing neuroprotection during carotid artery stenting. Catheter Cardiovasc Interv 80:1060–1068

    Article  PubMed  Google Scholar 

  33. Ohki T, Parodi J, Veith FJ et al (2001) Efficacy of a proximal occlusion catheter with reversal of flow in the prevention of embolic events during carotid artery stenting: an experimental analysis. J Vasc Surg 33:504–509

    Article  PubMed  CAS  Google Scholar 

  34. Rapp JH, Zhu L, Hollenbeck K et al (2009) Distal filtration versus flow reversal: an ex vivo assessment of the choices for carotid embolic protection. J Vasc Surg 49:1181–1188

    Article  PubMed  Google Scholar 

  35. Montorsi P, Caputi L, Galli S et al (2011) Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 58:1656–1663

    Article  PubMed  Google Scholar 

  36. Bijuklic K, Wandler A, Hazizi F, Schofer J (2012) The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 59:1383–1389

    Article  PubMed  Google Scholar 

  37. Bijuklic K, Wandler A, Varnakov Y et al (2013) Risk factors for cerebral embolization after carotid artery stenting with embolic protection: a diffusion-weighted magnetic resonance imaging study in 837 consecutive patients. Circ Cardiovasc Interv 6:311–316

    Article  PubMed  Google Scholar 

  38. Bendszus M, Koltzenburg M, Burger R et al (1999) Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 354:1594–1597

    Article  PubMed  CAS  Google Scholar 

  39. Wasser K, Pigram-Pastor SM, Schaudigel S et al (2001) New brain lesions after carotid revascularisation are not associated with cognitive performance. J Vasc Surg 53:61–70

    Article  Google Scholar 

  40. Timaran CH, Rosero EB, Martinez AE et al (2010) Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg 52:1188–1194

    Article  PubMed  Google Scholar 

  41. Rapp JH, Wakil L, Sawhney R et al (2007) Subclinical embolization after carotid artery stenting: new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg 45:867–872

    Article  PubMed  Google Scholar 

  42. Bijuklic K, Wandler A, Tübler T, Schofer J (2013) Impact of asymptomatic cerebral lesions in diffusion-weighted magnetic resonance imaging after carotid artery stenting. JACC Cardiovasc Interv 6:394–398

    Article  PubMed  Google Scholar 

  43. Maggio P, Altamura C, Landi D et al (2013) Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment. J Neurol Sci 328:58–63

    Article  PubMed  Google Scholar 

  44. Fairman R, Gray WA, Scicli AP et al (2007) The CAPTURE registry: analysis of strokes resulting from carotid artery stenting in the post approval setting: timing, location, severity, and type. Ann Surg 246:551–558

    Article  PubMed  Google Scholar 

  45. Schofer J, Arendt M, Tübler T et al (2008) Late cerebral embolization after emboli-protected carotid artery stenting assessed by sequential diffusion-weighted magnetic resonance imaging. JACC Cardiovasc Interv 1:571–577

    Article  PubMed  Google Scholar 

  46. Abou-Chebl A, Yadav JS, Reginelli JP et al (2004) Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment. J Am Coll Cardiol 43:1596–1601

    Article  PubMed  Google Scholar 

  47. Grunwald IQ, Politi M, Reith W et al (2009) Hyperperfusion syndrome after carotid stent angioplasty. Neuroradiology 51:169–174

    Article  PubMed  CAS  Google Scholar 

  48. Spetzler RF, Wilson CB, Weinstein P et al (1978) Normal perfusion pressure breakthrough theory. Clin Neurosurg 25:651–672

    PubMed  CAS  Google Scholar 

  49. Kang HS, Han MH, Kwon OK et al (2007) Intracranial hemorrhage after carotid angioplasty: a pooled analysis. J Endovasc Ther 14:77–85

    Article  PubMed  Google Scholar 

  50. Reimers B, Schlüter M, Castriota F et al (2004) Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients. Am J Med 116:217–222

    Article  PubMed  Google Scholar 

  51. Casserly IP, Abou-Chebl A, Fathi RB et al (2005) Slow-flow phenomenon during carotid artery intervention with embolic protection devices: predictors and clinical outcome. J Am Coll Cardiol 46:1466–1472

    Article  PubMed  Google Scholar 

  52. Ecker RD, Guidot CA, Hanel RA et al (2005) Perforation of external carotid artery branch arteries during endoluminal carotid revascularization procedures: consequences and management. J Invasive Cardiol 17:292–295

    PubMed  Google Scholar 

  53. Roubin GS, Yadav S, Iyer SS, Vitek J (1996) Carotid stent-supported angioplasty: a neurovascular intervention to prevent stroke. Am J Cardiol 78:8–12

    Article  PubMed  CAS  Google Scholar 

  54. Al-Mubarak N, Roubin GS, Vitek JJ et al (2001) Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation 104:1999–2002

    Article  PubMed  CAS  Google Scholar 

  55. Wholey MH, Al-Mubarak N (2003) Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv 60:259–266

    Article  PubMed  Google Scholar 

  56. Setacci C, Donato G de, Setacci F et al (2005) In-stent restenosis after carotid angioplasty and stenting: a challenge for the vascular surgeon. Eur J Vasc Endovasc Surg 29:601–607

    Article  PubMed  CAS  Google Scholar 

  57. Shawl FA (2002) Carotid artery stenting: acute and long-term results. Curr Opin Cardiol 17:671–676

    Article  PubMed  Google Scholar 

  58. Levy EL, Hanel RA, Lau T et al (2005) Frequency and management of recurrent stenosis after carotid artery stent implantation. J Neurosurg 102:29–37

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Schofer und K. Bijuklic geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Medizinisches Versorgungszentrum Prof. Mathey, Prof. Schofer, Universitäres Herz- und Gefäßzentrum Hamburg, Wördemannsweg 25–27, 22527, Hamburg, Deutschland

    J. Schofer & K. Bijuklic

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  1. J. Schofer
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  2. K. Bijuklic
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Correspondence to J. Schofer.

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Schofer, J., Bijuklic, K. Technik der Karotis-PTA. Herz 38, 706–713 (2013). https://doi.org/10.1007/s00059-013-3962-4

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