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Kriterien für ein komplikationsarmes Stenting der A. carotis interna

Criteria for low-complication stenting of the internal carotid artery

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Zusammenfassung

Hintergrund

Der „golden standard“ der Behandlung von Stenosen der A. carotis interna (ACI) ist die Karotisthrombendarteriektomie (CEA). Nach der aktuellen Leitlinie ist das Karotisstenting (CAS) eine Alternative. In mehreren prospektiven randomisierten Multi-Center-Studien zeigte CAS gegenüber CEA jedoch eine signifikant erhöhte periinterventionelle Schlaganfallrate. Diese Studien sind jedoch meist von einer großen Heterogenität bei der Durchführung von CAS gekennzeichnet.

Material und Methoden

In einer retrospektiven Analyse von 2012 bis 2020 wurden 202 symptomatische und symptomfreie Patienten mittels CAS therapiert. Es erfolgte eine sorgfältige Vorselektionierung der Patienten nach anatomischen und klinischen Kriterien. In allen Fällen wurden die gleiche Vorgehensweise und das gleiche Material gewählt. Alle Interventionen wurden ausschließlich durch 5 erfahrene Operateure durchgeführt. Ausgewertet wurden die anatomischen und klinischen Kriterien im Hinblick auf die perioperative Komplikationsrate. Primäre Endpunkte waren perioperativer Tod und Apoplex.

Ergebnisse

Bei 77 % der Patienten lag eine symptomfreie, bei 23 % eine symptomatische Karotisstenose vor. Das Durchschnittsalter war 66 Jahre. Der durchschnittliche Stenosegrad betrug 81 %. Die technische Erfolgsrate der CAS war 100 %. Unerwünschte periprozedurale Komplikationen traten in 1,5 % auf. Im Rahmen der Intervention ereigneten sich 1 „major stroke“ (0,5 %) und 2 „minor strokes“ (1 %).

Schlussfolgerungen

Die Ergebnisse dieser Studie weisen darauf hin, dass nach vorhergehender Patientenselektion anhand anatomischer und klinischer Kriterien CAS mit geringen Komplikationsraten durchgeführt werden kann. Eine Standarisierung von Materialien und Prozedur, konzentriert auf erfahrene Operateure mit entsprechendem Training sind entscheidend.

Graphic abstract

Abstract

Background

The gold standard for the treatment of internal carotid artery (ACI) stenosis is carotid thrombendarterectomy (CEA); however, according to the current guidelines, carotid artery stenting (CAS) is an alternative. In several prospective multicenter randomized studies, CAS showed a significantly increased peri-interventional stroke rate compared to CEA; however, these studies are usually characterized by a great heterogeneity in the procedure of CAS.

Material and methods

In a retrospective analysis from 2012 to 2020, 202 symptomatic and asymptomatic patients were treated with CAS. Patients were carefully preselected according to anatomical and clinical criteria. In all cases the same steps and material was used. All interventions were performed exclusively by five experienced surgeons. The anatomical and clinical criteria were evaluated with respect to the perioperative complication rate. The primary endpoints of the study were perioperative death and stroke.

Results

Asymptomatic carotid stenosis was present in 77% of the patients and symptomatic in 23%. The mean age was 66 years. The average degree of stenosis was 81%. The technical success rate of CAS was 100%. Adverse periprocedural complications occurred in 1.5%. During the intervention one major stroke (0.5%) and two minor strokes (1%) occurred.

Conclusion

The results of this study indicate that through a strict patient selection based on anatomical and clinical criteria, CAS can be performed with low complication rates. A standardization of materials and procedures, focused on experienced surgeons with appropriate training, is crucial.

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Authors and Affiliations

  1. Abteilung der Gefäßchirurgie, Bonifatius Hospital Lingen, Wilhelmstraße 13, 49808, Lingen, Deutschland

    Paolo Calo & Hartmut Görtz

  2. Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum Münster, Münster, Deutschland

    Alexander Oberhuber

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  1. Paolo Calo
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Correspondence to Paolo Calo.

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Interessenkonflikt

P. Calo und H. Görtz geben an, Honorare für Vorträge von der Firma Boston Scientific zu bekommen. A. Oberhuber gibt an, dass kein Interessenkonflikt besteht.

Alle beschriebenen retrospektive Untersuchungen am Menschen wurden mit Zustimmung der Ethik-Kommission der Ärztekammer Westfalen-Lippe und der Westfälischen Wilhelms-Universität Münster, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patient/-innen liegt eine Einverständniserklärung vor.

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Calo, P., Oberhuber, A. & Görtz, H. Kriterien für ein komplikationsarmes Stenting der A. carotis interna. Gefässchirurgie 27, 509–516 (2022). https://doi.org/10.1007/s00772-022-00940-y

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