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Karotisstenose als Zusatzbefund bei koronarer Herzkrankheit

Carotid stenosis concomitant to coronary artery disease

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Zusammenfassung

Eine Karotisstenose ist ein häufiger Zusatzbefund bei Patienten mit koronarer Herzerkrankung (KHK). Nach Literaturangaben kann bei 9–28% der Patienten mit KHK eine zusätzliche Stenose der Karotisstrombahn diagnostiziert werden. Prädiktoren für die Koinzidenz einer Karotisstenose und KHK sind ein fortgeschrittenes Alter, Rauchen, Diabetes mellitus, arterielle Hypertonie, das Vorliegen einer koronaren Mehrgefäßerkrankung und eine periphere arterielle Verschlusserkrankung. Auch bei Patienten mit instabilem Koronarsyndrom und bei erhöhten laborchemischen Inflammationsmarkern wie dem C-reaktiven Protein oder Fibrinogen ist häufiger eine zusätzliche Karotisstenose nachweisbar. Das Vorliegen einer zusätzlichen Karotisstenose führt zu einer signifikanten Verschlechterung der Gesamtprognose. Patienten mit einer KHK sollten daher zusätzlich auf das Vorliegen einer Karotisstenose untersucht werden, insbesondere wenn eine Koronarbypass-Operation vorgesehen ist. Als geeignete Screeningmethode stehen uns hier die cw-Dopplersonographie und farbkodierte Duplexsonographie zur Verfügung.

Abstract

Carotid stenosis is frequent in patients with coronary artery disease (CAD). In the literature, 9–28% of patients with CAD have additional carotid artery stenosis, predictors of which are advanced age, smoking, diabetes mellitus, arterial hypertension, coronary multivessel disease, and peripheral arterial disease. Moreover, patients with unstable coronary syndromes and those with elevated inflammatory markers such as C-reactive protein or fibrinogen more often have concomitant CAD and carotid artery stenosis. The long-term prognosis of these patients is worse than with CAD only. Therefore, patients with CAD should be screened for additional carotid artery stenosis, especially if coronary artery bypass grafting is planned. Continuous wave Doppler sonography and color-coded duplex sonography are suitable methods to screen for carotid artery stenosis.

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  1. II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz

    Ch. Espinola-Klein, H.-J. Rupprecht & J. Meyer

  2. II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 , Mainz

    Ch. Espinola-Klein

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  1. Ch. Espinola-Klein
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  2. H.-J. Rupprecht
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  3. J. Meyer
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Correspondence to Ch. Espinola-Klein.

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Espinola-Klein, C., Rupprecht, HJ. & Meyer, J. Karotisstenose als Zusatzbefund bei koronarer Herzkrankheit. Chirurg 75, 667–671 (2004). https://doi.org/10.1007/s00104-004-0903-z

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