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Konzepte zur Gefäßvorbereitung („vessel preparation“) in der modernen Gefäßmedizin

Studienlage, Anwendungsgebiete und Limitationen

Vessel preparation concepts in modern vascular medicine

Current evidence, fields of application and limitations

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Zusammenfassung

In der endovaskulären Therapie peripherer Arterien zeigen sich in den letzten Jahren, trotz großer Fortschritte, weiterhin Einschränkungen. Um diesen Einschränkungen, insbesondere der Entwicklung von Restenosen im mittelfristigen Verlauf, entgegenzuwirken, wurden spezielle medikamentenbeschichtete Ballons („drug-coated balloons“; DCBs) entwickelt, deren Wirksamkeit, insbesondere bei stark kalzifizierten Gefäßen, jedoch begrenzt ist. Aus diesem Grund werden vor der definitiven Versorgung mit DCBs oder medikamentenbeschichteten Stents („drug-eluting stents“; DES) verschiedene Behandlungsmodalitäten, die unter dem Allgemeinbegriff „Vessel Preparation“ bekannt sind, eingesetzt. Als Ziel haben die genannten Behandlungen die Plaquereduktion oder -modifikation, die in einer Reduktion der flusslimitierenden Dissektionen nach der Angioplastie sowie einer erhöhten Medikamentenaufnahme an der Gefäßwand resultieren. Mit vielversprechenden Ergebnissen spielen verschiedene Atherektomiegeräte, Spezialballonkatheter (Scoring‑, Cutting- und minimaltraumatische Ballons) sowie die endovaskuläre Lithotripsie eine wichtige Rolle bei der Gefäßvorbereitung. Allerdings haben diese Behandlungsmodalitäten auch Limitationen. Diese sind unter anderem hohe Anschaffungskosten, ein erhöhtes technisches Anforderungsniveau an den Behandler, sowie das Risiko von Komplikationen, die oftmals eine Bail-out-Lösung erfordern. In diesem Beitrag wird eine Übersicht der aktuellen Datenlage über die Gefäßvorbereitung mit den dazugehörigen Zielen, Indikationen und Einschränkungen dieser Behandlung vorgestellt.

Abstract

Despite rapid advancements in recent years, endovascular treatment of peripheral arteries still has limitations, with the risk of restenosis being a major one. To combat this, drug-coated balloons (DCB) were introduced which, however, also have their own limitations, especially in heavily calcified arteries. Vessel preparation is a group of procedures used before the definitive treatment with DCB or drug-eluting stents (DES) to remove or modify part of the atherosclerotic plaque (debulking) and thus minimize the risk of flow-limiting dissections after angioplasty as well as facilitating increased drug-uptake of the arterial wall. Various atherectomy devices, special balloon catheters (scoring, cutting and minimally traumatic balloons) and endovascular lithotripsy play an important role in vessel preparation with promising results; however, these treatment modalities are not without their limitations and risks, including high purchasing costs, a steeper technical learning curve and possible complications that often require bail-out measures. The aim of this article is to present an overview of the currently available data from the literature on vessel preparation, with the corresponding indications, goals, and limitations of these treatment modalities.

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Authors and Affiliations

  1. Abteilung für Gefäßchirurgie, Klinikum der Universität München, LMU München, Marchioninistraße 15, 81377, München, Deutschland

    Nikolaos Konstantinou, Konstantinos Stavroulakis, Jan Stana, Barbara Rantner, Tugce Öz, Mohamed Essa, Nikolaos Tsilimparis & Dimitrios Kapetanios

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  1. Nikolaos Konstantinou
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  2. Konstantinos Stavroulakis
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Correspondence to Nikolaos Konstantinou.

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Interessenkonflikt

K. Stavroulakis macht folgende Angaben: Consulting für Phillips, Shockwave, Terumo und Boston Scientific. Received Honoraria von Medtronic, Boston Scientific, Biotronic, Bentley und Abbott. N. Tsilimparis macht folgende Angabe: Proctoring für COOK Medical. N. Konstantinou, J. Stana, B. Rantner, T. Öz,M. Essa und D. Kapetanios geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Konstantinou, N., Stavroulakis, K., Stana, J. et al. Konzepte zur Gefäßvorbereitung („vessel preparation“) in der modernen Gefäßmedizin. Gefässchirurgie 28, 189–198 (2023). https://doi.org/10.1007/s00772-023-00993-7

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