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Erkrankungen der hirnversorgenden Gefäße

Cerebrovascular diseases

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Zusammenfassung

Erkrankungen der hirnversorgenden Arterien sind überwiegend durch eine Arteriosklerose bedingt. Die Diagnose kann meistens durch die Duplexsonographie gestellt werden. Der Behandlung kardiovaskulärer Risikofaktoren kommt eine zentrale Bedeutung bei arteriosklerotischen Obstruktionen zu. Bei symptomatischen Patienten mit einer >70%igen Stenose der A. carotis interna besteht eine gesicherte Indikation zur Revaskularisierung. Symptomfreie Patienten mit einer Stenose >60% profitieren nur von einer Revaskularisierung, wenn das perioperative Risiko für Schlaganfall oder Tod <3% ist. Die optimale Revaskularisationsstrategie hängt vom Risikoprofil des Patienten und der lokalen Expertise der chirurgisch und interventionell tätigen Ärzte ab. Gerade bei jüngeren Patienten mit Erkrankungen der hirnversorgenden Gefäße sollte auch an seltenere Ursachen wie eine Dissektion, Großgefäßvaskulitis, fibromuskuläre Dysplasie oder Vasospasmen gedacht werden.

Abstract

In the majority of the cases cerebrovascular disease is caused by atherosclerosis. Duplexsonography is the diagnostic tool of first choice. Management of cardiovascular risk factors is of paramount importance in secondary prevention of atherosclerotic vascular complications. Patients with a symptomatic internal carotid artery stenosis >70% have a clear indication for revascularization. Asymptomatic patients with >60% stenosis benefit from revascularisation if the perioperative risk for death or stroke is below 3%. The optimal revascularization strategy highly depends on the expertise of the local surgeon or endovascular specialist. In younger patients with cerebrovascular disease rare causes such as dissection, large vessel arteritis, fibromuscular dysplasia or vasospasms have to be considered.

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  1. Abteilung Angiologie, Medizinische Poliklinik – Standort Innenstadt, Klinikum der Ludwig-Maximilians-Universität, Pettenkoferstraße 8, 80336, München, Deutschland

    P.J. Kuhlencordt, J. Röling & U. Hoffmann

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  1. P.J. Kuhlencordt
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Correspondence to P.J. Kuhlencordt.

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Kuhlencordt, P., Röling, J. & Hoffmann, U. Erkrankungen der hirnversorgenden Gefäße. Internist 50, 945–951 (2009). https://doi.org/10.1007/s00108-009-2367-1

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