Aktuelle Studienlage zu Karotisangioplastie und -stenting

Zusammenfassung

Die Prävalenz extrakranieller Stenosen der Arteria carotis interna (ACI) beträgt in der 6. Lebensdekade 0,5 %, steigt um das 80. Lebensjahr jedoch auf etwa 10 % an. Karotisstenosen sind die Ursache von etwa 10 % aller ischämischen Hirninfarkte und von etwa 15 % aller transitorischen ischämischen Attacken (TIA). Das Rezidivrisiko für eine erneute zerebrale Ischämie aufgrund einer unbehandelten Karotisstenose beträgt innerhalb der ersten 3 Monate nahezu 20 %. Die Behandlung der Karotisstenose nimmt daher in der Schlaganfallprävention eine herausragende Rolle ein. Dieser Artikel widmet sich schwerpunktmäßig der gegenwärtigen Studienlage zur perkutanen Karotisangioplastie mit Stentimplantation im Vergleich zur Karotisthrombendarterektomie. Zusammenfassend stellen wir den gegenwärtigen Standpunkt des Calgary Stroke Programs der University of Calgary und des Dresdner Universitäts Schlaganfall Centrums als Beispiele für ein nordamerikanisches und ein deutsches Schlaganfallzentrum zum konkreten Vorgehen bei Patienten mit extrakraniellen Karotisstenosen dar.

Abstract

Population-based studies indicate that the prevalence of carotid stenosis is 0.5 % in the sixth decade of life but increases up to 10 % by the age of 80 years. Ipsilateral carotid stenosis, with > 50 % of the artery occluded, is found in about 10 % of carotid territory ischemic strokes and in about 15 % of transient ischemic attacks (TIA), and is associated with a high-risk of recurrent stroke. Treatment of carotid artery disease plays a major role in stroke prevention. In this article we focus on the role of carotid artery angioplasty and stenting as compared with carotid endarterectomy. We summarize the current positions of the Calgary Stroke Program and the Dresden University Stroke Centre in the treatment of patients with extracranial carotid stenosis as examples for a North American and a German Stroke Centre.

Stenting - Endarterektomie - Karotis - Stenose

stenting - endarterectomy - carotid artery - stenosis

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