Therapie bei asymptomatischer Stenose der extrakraniellen A. carotis

Für die asymptomatische Karotisstenose, definiert als eine arteriosklerotische Karotisstenose mit neurologischer Symptomfreiheit seit über 6 Monaten, gibt es im Gegensatz zur symptomatischen Karotisstenose immer noch keine sicheren Behandlungsempfehlungen. Dieser Beitrag beschreibt die auf der aktuellen Datenlage basierenden möglichen Therapieempfehlungen.

Abstract

For the asymptomatic carotid stenosis, defined as an atherosclerotic carotid stenosis without neurological symptoms for more than 6 months, there are in contrast to a symptomatic carotid stenosis still no reliable treatment recommendations. Possible therapy recommendations based on current data are presented below.

Schlüsselwörter

asymptomatische Karotisstenose - Karotis-Thrombendarterektomie - Karotisstenting - konservative Therapie - Schlaganfall-Primärprophylaxe

Key words

asymptomatic carotid stenosis - carotid endarterectomy - carotid artery stenting - best medical therapy - stroke prevention

Publication History

Article published online:
15 June 2021

• Literatur

• 1 Eckstein H, Kühnl A, Berkefeld J. et al S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der extracraniellen Carotisstenose (2. Auflage). AWMF-Registernummer 004-028. https://www.awmf.org/leitlinien/detail/ll/004-028.html ; Stand: 09.04.2021
• 2 Marquardt L, Geraghty OC, Mehta Z. et al Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective, population-based study. Stroke 2010; 41: e11-e17 DOI: 10.1161/STROKEAHA.109.561837.
• 3 Heuschmann PU, Busse O, Wagner M. et al Schlaganfallhäufigkeit und Versorgung von Schlaganfallpatienten in Deutschland. Akt Neurol 2010; 37: 333-340 DOI: 10.1055/s-0030-1248611.
• 4 Arning C, Widder B, von Reutern GM. et al [Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement]. Ultraschall in Med 2010; 31: 251-257 DOI: 10.1055/s-0029-1245336.
• 5 Velz J, Esposito G, Wegener S. et al [Diagnostic and Therapeutic Management of Carotid Artery Disease]. Praxis 2020; 109: 705-723 DOI: 10.1024/1661-8157/a003475.
• 6 Rothwell PM, Eliasziw M, Gutnikov SA. et al Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361: 107-116 DOI: 10.1016/s0140-6736(03)12228-3.
• 7 Bonati LH, Dobson J, Algra A. et al Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 2010; 376: 1062-1073 DOI: 10.1016/S0140-6736(10)61009-4.
• 8 Spence JD. Management of asymptomatic carotid stenosis. Ann Transl Med 2020; 8: 1262 DOI: 10.21037/atm-20-975.
• 9 Amarenco P, Kim JS, Labreuche J. et al A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke. N Engl J Med 2020; 382: 9 DOI: 10.1056/NEJMoa1910355.
• 10 Bhatt DL, Eikelboom JW, Connolly SJ. et al Role of Combination Antiplatelet and Anticoagulation Therapy in Diabetes Mellitus and Cardiovascular Disease: Insights From the COMPASS Trial. Circulation 2020; 141: 1841-1854 DOI: 10.1161/CIRCULATIONAHA.120.046448.
• 11 Renaud S, de Lorgeril M, Delaye J. et al Cretan Mediterranean diet for prevention of coronary heart disease. Am J Clin Nutr 1995; 61: 1360S-1367S DOI: 10.1093/ajcn/61.6.1360S.
• 12 Chiuve SE, Rexrode KM, Spiegelman D. et al Primary prevention of stroke by healthy lifestyle. Circulation 2008; 118: 947-954 DOI: 10.1161/CIRCULATIONAHA.108.781062.
• 13 Friedman SG. The first carotid endarterectomy. J Vasc Surg 2014; 60: 1703-1708.e1–e4 DOI: 10.1016/j.jvs.2014.08.059.
• 14 Rantner B. Symptomatische und asymptomatische Karotisstenose: Leitlinienbasierte Therapie. Gefäßmedizin Scan 2020; 7: 233-246 DOI: 10.1055/a-1225-1207.
• 15 Mathias K. Perkutane transluminale Katheterbehandlung supraaortaler Arterienobstruktionen. Angio 1981; 3: 47-50
• 16 Hobson 2nd RW, Weiss DG, Fields WS. et al Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med 1993; 328: 221-227 DOI: 10.1056/NEJM199301283280401.
• 17 Halliday A, Mansfield A, Marro J. et al Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363: 1491-1502 DOI: 10.1016/S0140-6736(04)16146-1.
• 18 Study ECftACA. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273: 1421-1428 DOI: 10.1001/jama.1995.03520420037035.
• 19 Cambria RP, Conrad MF. Asymptomatic carotid stenosis: Revisionist history is usually wrong. J Vasc Surg 2020; 71: 2-4 DOI: 10.1016/j.jvs.2019.05.029.
• 20 Reiff T, Eckstein HH, Mansmann U. et al Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2. Int J Stroke 2019; 15: 1747493019833017 DOI: 10.1177/1747493019833017.
• 21 Spence JD, Tamayo A, Lownie SP. et al Absence of microemboli on transcranial Doppler identifies low-risk patients with asymptomatic carotid stenosis. Stroke 2005; 36: 2373-2378 DOI: 10.1161/01.STR.0000185922.49809.46.
• 22 Saba L, Saam T, Jager HR. et al Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol 2019; 18: 559-572 DOI: 10.1016/S1474-4422(19)30035-3.
• 23 Paraskevas KI, Veith FJ, Spence JD. How to identify which patients with asymptomatic carotid stenosis could benefit from endarterectomy or stenting. Stroke Vasc Neurol 2018; 3: 92-100 DOI: 10.1136/svn-2017-000129.
• 24 King A, Serena J, Bornstein NM. et al Does impaired cerebrovascular reactivity predict stroke risk in asymptomatic carotid stenosis? A prospective substudy of the asymptomatic carotid emboli study. Stroke 2011; 42: 1550-1555 DOI: 10.1161/STROKEAHA.110.609057.
• 25 Wang Z, Korantzopoulos P, Liu T. Carotid Atherosclerosis in Patients with Atrial Fibrillation. Curr Atheroscler Rep 2019; 21: 55 DOI: 10.1007/s11883-019-0808-4.
• 26 Brott TG, Calvet D, Howard G. et al Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data. Lancet Neurol 2019; 18: 348-356 DOI: 10.1016/S1474-4422(19)30028-6.
• 27 Cui L, Han Y, Zhang S. et al Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery Stenosis: A Meta-Analysis of Randomised Controlled Trials. Eur J Vasc Endovasc Surg 2018; 55: 614-624 DOI: 10.1016/j.ejvs.2018.02.020.
• 28 Musialek P, Roubin GS. Commentary: Double-Layer Carotid Stents: From the Clinical Need, through a Stent-in-Stent Strategy, to Effective Plaque Isolation... the Journey Toward Safe Carotid Revascularization Using the Endovascular Route. J Endovasc Ther 2019; 26: 572-577 DOI: 10.1177/1526602819861546.
• 29 Mutzenbach SJ, Millesi K, Roesler C. et al The Casper Stent System for carotid artery stenosis. J Neurointerv Surg 2018; 10: 869-873 DOI: 10.1136/neurintsurg-2017-013583.