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Indikationen zur Therapie von Stenosen der A. carotis

Indications for treating stenoses of the carotid artery

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Zusammenfassung

Das jährliche Schlaganfallrisiko bei asymptomatischer Karotisstenose beträgt ca. 1% bei Patienten mit weniger als 70%igen Stenosen (NASCET-Methodik) und 2–5% bei über 70%igen Stenosen der A. carotis interna. Das Rezidivrisiko symptomatischer Stenosen ist mit ca. 15% im 1. Jahr beträchtlich höher. Seit über 10 Jahren ist die Effektivität der Karotisthrombendarteriektomie (CEA) in der Sekundärprävention symptomatischer Karotisstenosen bewiesen, auch nimmt die Evidenz zu, dass sie bei asymptomatischen Stenosen von Nutzen ist. Von besonderer Effektivität ist die CEA bei hochgradigen Stenosen, Männern, älteren Patienten und bei bilateralen Prozessen. Eine differenzierte Haltung ist gegenüber der interventionellen, endovaskulären Therapie notwendig. Vielerorts wird diese Therapie aufgrund einer im Vergleich zur CEA scheinbar geringeren Invasivität zu unkritisch indiziert und durchgeführt. Es gibt sicher bereits zahlreiche Erfahrungen mit dieser Therapie, aber nach den Grundsätzen der evidenzbasierten Medizin ist die Effektivität der stentgeschützen Angioplastie bisher nicht unter Beweis gestellt worden. Insbesondere bei Patienten mit symptomatischer Karotisstenose sollte dieses Verfahren überwiegend im Rahmen randomisierter Studien (z. B. SPACE) angewandt werden.

Abstract

The annual stroke risk for patients with asymptomatic stenoses of the carotid artery is around 1% in case of <70% stenosis (NASCET criteria) and 2–5% in patients with >70% stenosis. The risk of recurrent ischemic events for patients with symptomatic stenoses is much higher, around 15% during the first year. For more than 10 years, the efficacy of carotid surgery has been proven, and there is growing evidence to support surgery in case of asymptomatic stenosis. Patients with severe stenoses, male or elderly patients, and those with bilateral stenoses benefit more from surgery. Carotid artery stenting has not proven its safety or efficacy. Despite this lack of evidence, the method is used in many centers as an alternative to surgery. Especially symptomatic carotid artery stenosis should be used mainly in the setting of a randomized trial such as SPACE.

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Authors and Affiliations

  1. Neurologische Klinik, Ruprecht-Karls-Universität Heidelberg

    P. Ringleb, A. Kunze &  W. Hacke

  2. Neurologische Klinik, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120 , Heidelberg

    W. Hacke

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  1. P. Ringleb
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  2. A. Kunze
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  3. W. Hacke
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Ringleb, P., Kunze, A. & Hacke, W. Indikationen zur Therapie von Stenosen der A. carotis. Chirurg 75, 653–657 (2004). https://doi.org/10.1007/s00104-004-0882-0

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  • DOI: https://doi.org/10.1007/s00104-004-0882-0

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