Die asymptomatische Karotisstenose: Was ist neu?

Was ist neu?

Indikation zur Revaskularisation asymptomatischer Karotisstenosen Mit einer optimalen medikamentösen Therapie kann eine vergleichbare Risikoreduktion wie mit einer Revaskularisation erreicht werden. Daher empfiehlt die aktualisierte S3-Leitlinie, die Indikation zur Revaskularisation einer asymptomatischen hochgradigen Karotisstenose unter sorgfältiger Risiko-Nutzen-Abwägung individualisiert zu treffen. Voraussetzung ist, dass kein erhöhtes Operationsrisiko besteht und ein oder mehrere klinische oder bildgebende Befunde vorliegen, die mit einem erhöhten Schlaganfallrisiko assoziiert sind. Die periprozedurale Schlaganfallrate/Letalität soll maximal 2 % betragen.

Optimierte konservative Therapie (BMT) Die Einnahme von ASS (100 mg/Tag) führt bei Patienten mit asymptomatischer Karotisstenose zu einer signifikanten Reduktion der 5-Jahres-Mortalität auch nach Adjustierung für andere Risikofaktoren. Ein LDL-Zielwert < 70 mg/dl führt im Vergleich zu einem Zielwert von 90–110 mg/dl zu einer signifikant größeren Reduktion der Intima-Media-Dicke.

Abstract

In industrialized countries, stroke is still the most common disease that leads to permanent disability. Of the 250 000 strokes that occur annually in Germany, in about 80 % are cerebral ischemia. Approximately 15 % of these ischemias are caused by lesions of the extracranial internal carotid artery, so optimal treatment of extracranial carotid stenosis is essential [1]. This continues to be the subject of a controversial debate, as optimized drug therapy has led to a significant reduction in risk.

In 2020, the multidisciplinary S3 guideline for the management of extracranial carotid stenoses was updated. In the following, current aspects and new recommendations for asymptomatic carotid stenosis are presented and important innovations of the guideline are explained.

Schlüsselwörter

Karotisstenose - Schlaganfall - Leitlinie - konservative Therapie - Revaskularisation

Key words

carotid stenosis - stroke - guideline - best medical treatment - revaskularisation

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