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Diagnostische Aspekte der instabilen Plaque bei asymptomatischen Karotisstenosen

Diagnostic aspects of recognizing plaque instability in asymptomatic carotid stenoses

  • Leitthema: Arteriosklerose und Screening
  • Published:
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Zusammenfassung

Bei insgesamt niedrigem jährlichen Schlaganfallrisiko bei Patienten mit asymptomatischer Stenose der A. carotis interna kann keine generelle Therapieempfehlung zugunsten einer interventionellen Behandlung gegeben werden, obwohl sich aufgrund der aktuell publizierten Daten der ACST-Studie das Indikationsspektrum erweitern könnte. Es erscheint deshalb erstrebenswert, risikomodulierende Faktoren zu charakterisieren, um asymptomatische Patienten mit einem besonders hohen Schlaganfallrisiko identifizieren zu können. Aus der aktuellen Datenlage lassen sich zumindest 3 relevante Indikatoren identifizieren: zunehmender Stenosegrad zwischen 60 und 90%, reduzierte ipsilaterale Vasoreaktivität und das Auftreten von zerebralen Mikroembolien in der transkraniellen Dopplerlangzeitregistrierung. Dem Verlauf der Serumkonzentration des C-reaktiven Proteins könnte eine Bedeutung zukommen. Diese Daten beruhen allerdings vielfach auf monozentrischen Beobachtungsstudien, eine stratifizierende Interventionsstudie existiert bislang nicht.

Abstract

Intervention in patients with asymptomatic carotid artery stenosis cannot be generally recommended due to the low expected annual stroke rate, although recent data from the ACST study could broaden the indication spectrum. It therefore seems desirable to define risk-modulating factors to identify asymptomatic patients with a higher risk of stroke. Reviewing the current literature, at least three indicators can be recognized: an increasing grade of stenosis between 60 and 90%, a reduced ipsilateral vasoreactivity, and the occurrence of cerebral microembolism registered by transcranial long-term microemboli detection. The serum course of CRP might become another prognostic factor. However, these data result from single center studies; stratifying interventional studies do not yet exist.

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  1. Klinik für Neurologie, Zentrum der Neurologie und Neurochirurgie, Johann Wolfgang Goethe-Universität Frankfurt am Main

    M. Sitzer

  2. Klinik für Neurologie, Zentrum der Neurologie und Neurochirurgie, Johann Wolfgang Goethe-Universität Frankfurt am Main, Schleusenweg 2–16, 60528 , Frankfurt

    M. Sitzer

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  1. M. Sitzer
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Correspondence to M. Sitzer.

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Sitzer, M. Diagnostische Aspekte der instabilen Plaque bei asymptomatischen Karotisstenosen. Gefässchirurgie 9, 180–184 (2004). https://doi.org/10.1007/s00772-004-0357-0

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  • DOI: https://doi.org/10.1007/s00772-004-0357-0

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