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Stentimplantation im Bereich der Karotisstrombahn in der Verantwortung des Gefäßchirurgen

Carotid artery stenting in the hands of the vascular surgeon

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Zusammenfassung

Die Stentimplantation im Bereich der A. carotis („carotid artery stenting“, CAS) ist eine anerkannte Therapieoption für Patienten mit Stenosierungen im Bereich der Karotisstrombahn („carotid arterial occlusive disease“, CAOD). Dennoch kann eine falsche Auswahl des Patientguts zu einem schlechten Ergebnis des CAS führen. Daher ist es von herausragender Bedeutung, dass die Durchführung dieses Verfahrens unter den best möglichen Voraussetzungen und von der qualifiziertesten Person durchgeführt wird. Durch die langjährige Erfahrung in der Behandlung von CAOD ist ein gut ausgebildeter Gefäßchirurg der optimale Kandidat für die interventionelle Behandlung im Bereich der Karotisstrombahn.

Der Gefäßchirurg ist mit der Pathologie und der individuellen Indikationsstellung vollständig vertraut. Durch die Einsatzmöglichkeit beider Therapieoptionen (CAS und CEA) ist ihm bekannt, dass beide Techniken in der Behandlung von Stenosierungen im Bereich der Karotisstrombahn nicht miteinander konkurrieren, sondern sich ergänzen. Mögliche Komplikationen während und nach einer CAS sind dem Gefäßchirurgen sehr vertraut, und aufgrund seiner langjährigen Erfahrung in der Nachsorge operativ versorgter Patienten ist auch eine gute Nachbehandlung sichergestellt. Durch die operative Erfahrung mit der Plaquemorphologie ist es ihm möglich, das beste Protektionssystem (EPD) und den entsprechenden Stent für jeden Fall individuell auszuwählen. Des Weiteren bietet die Entwicklung einer gefäßchirurgischen/-interventionellen Abteilung eine optimale Voraussetzung für die Durchführung von CAS und ebnet den Weg in die neue Ära der interventionellen Therapie.

Abstract

Carotid artery stenting (CAS) is an efficient treatment modality for patients suffering of carotid arterial occlusive disease (CAOD). However, careless patient selection can result in poor CAS outcome. Therefore, it is of the utmost importance that treatment be performed under optimal conditions by the person best capable of performing the procedure. Their long history of treating CAOD make well-trained vascular surgeons the perfect candidates to stent carotids.

They fully understand the pathology of the disease and know the indications for stenting. As they can offer both CAS and carotid endarterectomy (CEA) to their patients, it is obvious to them that these techniques are not concurrent, but complementary. They have full knowledge of possible complications during and after CAS and, as they were responsible for patient follow-up from the start of CEA, they are ideally placed to monitor their patients closely in the post-discharge phase. Their experience with operating carotid plaque provides them with knowledge of carotid lesion morphology and with the ability to appropriately select the best embolic protection device and stent for every specific case. In addition, the introduction of vascular intervention units further optimizes the ideal setting for CAS procedures and prepares them for the new era of vascular interventionalists.

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  1. Department of Vascular Surgery, AZ St-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium

    M. Bosiers, K. Deloose, J. Verbist & P. Peeters

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  1. M. Bosiers
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  2. K. Deloose
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  3. J. Verbist
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  4. P. Peeters
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Correspondence to M. Bosiers.

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Bosiers, M., Deloose, K., Verbist, J. et al. Stentimplantation im Bereich der Karotisstrombahn in der Verantwortung des Gefäßchirurgen. Gefässchirurgie 11, 245–252 (2006). https://doi.org/10.1007/s00772-006-0478-8

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  • DOI: https://doi.org/10.1007/s00772-006-0478-8

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