Findet MeVO: intrakranielle Verschlüsse mittelgroßer Gefäße in der CTA erkennen

Die Entwicklung von Methoden zur Erkennung und Behandlung von intrakraniellen LVO (Large Vessel Occlusions) hat die Behandlung akuter ischämischer Schlaganfälle revolutioniert. Die laufenden Bemühungen konzentrieren sich nun auf intrakranielle MeVO (Medium Vessel Occlusions). Das Verständnis der relevanten Anatomie und der verschiedenen Erscheinungsformen von MeVO hilft Radiologen bei der Erkennung dieser Verschlüsse.

Kernaussagen

• Die genaue und rechtzeitige radiologische Diagnose von MeVO im Kontext eines akuten Schlaganfalls ist eine wichtige Aufgabe für Radiologen.

• In Studien umfasst die Definition einer MeVO die Segmente M2–M3 der A. cerebri media, die Segmente A2–A3 der A. cerebri anterior und die Segmente P2–P3 der A. cerebri posterior. Die Segmente A1 der A. cerebri anterior und P1 der A. cerebri posterior sind ebenfalls in der Mehrzahl der MeVO-Definitionen der Studien enthalten.

• Die Identifizierung einer LVO mit modernen CTA-Protokollen ist relativ einfach. Die Erkennung von MeVO und DVO ist dagegen schwieriger: In früheren Studien wurde bis zu einem Drittel dieser Verschlüsse übersehen

• Schwierigkeiten bei der Erkennung von LVO und MeVO werden in zunehmendem Maße dokumentiert und umfassen mangelhafte CTA-Technik, sog. Stumpfverschlüsse, anatomische Varianten, subokklusive Gerinnsel und kalzifizierte Gerinnsel.

• Auch die Perfusions-CT kann bei der Identifizierung von MeVO helfen.

• Die Mehrphasen-CTA ist ein weiteres fortschrittliches bildgebendes Verfahren, das nachweislich bei der Erkennung von MeVO hilfreich ist.

Schlüsselwörter

Hirnarterien - mittelgroße Gefäße - Gefäßokklusion - CT-Angiografie

Publikationsverlauf

Artikel online veröffentlicht:
10. Juli 2025

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