Gefäßchirurgische Therapieoptionen an der A. carotis

Zusammenfassung

Die chirurgische Desobliteration der A. carotis interna ist eine effektive Option zur Primärund Sekundärprophylaxe des Schlaganfalls bei symptomatischen und hochgradigen asymptomatischen Stenosen (Evidenzlevel 1a). Symptomatische Karotisstenosen sollten zur Vermeidung früher Reapoplexe innerhalb von zwei Wochen nach dem Indexereignis operiert werden, das perioperative Risiko ist in Zentren mit ausreichender Erfahrung niedrig. Die Einhaltung eines möglichst kurzen Zeitfensters bis zur Operation kann durch interdisziplinäre Zusammenarbeit im Schlaganfallzentrum verbessert werden und ist ein wichtiger Qualitätsindikator. Die Indikation zur OP muss zentrumsspezifische Komplikationsraten berücksichtigen, die bei symptomatischer Karotisstenose für den kombinierten Endpunkt Schlaganfall/Tod unter 6%, bei asymptomatischer Karotisstenose unter 3% liegen müssen. Bei gleichem perioperativem Risiko sind Restenosen nach Eversionsendarteriektomie seltener, Vorteil der klassischen Thrombendarteriektomie mit Längsinzision ist die technisch problemlose Sicherstellung der Perfusion durch Shunteinlage. Eine konsequente Qualitätskontrolle ist unverzichtbarer Bestandteil der chirurgischen Therapie.

Schlüsselwörter

Schlaganfall - Karotisstenose - TEA/EEA

• Literatur

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