Zerebrale Protektionssysteme für die Behandlung der Karotisstenose - Eine Standortbestimmung

Zusammenfassung

Die Karotisbifurkation ist ein derzeit viel und kontrovers diskutiertes Gefäßterritorium. Dies gilt sowohl für die Diagnostik, mehr noch für die Therapie. Wird die Therapievariante Stent gewählt, bestehen kontroverse Ansichten, ob die Angioplastie ohne oder obligat mit zerebralem Protektionssystem zu erfolgen hat. Das Konzept der Protektion während der Karotisangioplastie bzw. Stentbehandlung zur Vermeidung zerebraler embolischer Komplikationen wurde erstmals von Théron et al. beschrieben. Heutzutage stehen als Protektionssysteme außer einer temporären Ballonokklusion temporäre Filtrationssysteme und Systeme zur Flussumkehr in der A. carotis interna (ACI) zur Verfügung. Es ist bis zum heutigen Tag noch nicht definiert, bis zu welcher minimalen Größe Emboli gestoppt werden müssen, um einen Schlaganfall zu verhindern. Die Relevanz zerebraler Mikroembolien ist ebenso unklar. Zerebrale Protektionssysteme können, wie erste klinische und in vitro Studien belegen konnten, in beachtlichem Maße das Risiko zerebraler Embolien reduzieren, wenngleich auch unter Protektion Embolien möglich sind. Ob der Einsatz von Protektionssystemen generell, wie von einigen Anwendern gefordert, erfolgen sollte, bleibt noch offen und ist durch weitere klinische Studien zu klären.

Abstract

The carotid bifurcation is currently a subject of controversial discussion within the vascular territory. These controversies are obvious for diagnostic imaging but the more so for therapy. Performing stenting as a treatment tool, controversies exist also as to whether angioplasty is performed without or obligatory with cerebral protection. Théron and colleagues first described the concept of cerebral protection during carotid angioplasty and stent placement. Currently, there are three temporary cerebral protection systems, i. e. balloon occlusion, filtration baskets, and systems for flow reversal in the internal carotid artery. While these systems provide a considerable degree of protection, as has been shown in in vitro and preliminary clinical studies, embolization might still occur, even under protection. In addition, it is still not clear what the minimum size of emboli is that need to be stopped to prevent a stroke, and what the relevance of cerebral microemboli is. Clinical evidence suggests that the usage of protection systems favours a good outcome of the intervention; however, whether or not such systems should be used routinely remains a matter of discussion and should thus be verified in further clinical studies.

Aa. carotides, Intervention - Interventionen, experimentell - Interventionen, Komplikationen - Embolien, klinisch und experimentell - Zerebrale Protektion

Carotid arteries, interventional procedures - Interventional procedures, experimental - Interventional procedures, complications - Embolism, clinical and experimental - Cerebral protection

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