Aktuelle Neurologie 2014; 41(01): 40-42
DOI: 10.1055/s-0033-1359972
Debatte: Pro & Kontra
© Georg Thieme Verlag KG Stuttgart · New York

Interventionelle Therapie von symptomatischen intrakraniellen Gefäßstenosen – Pro

Interventional Therapy of Symptomatic Intracranial Stenoses – Pro
J. Fiehler
1   Direktor der Klinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf
› Author Affiliations
Further Information

Publication History

Publication Date:
12 February 2014 (online)

Pro

Grundsätzliche Überlegungen

In der SAMMPRIS-Studie zeigte sich eine deutlich höhere Komplikationsrate im Behandlungsarm „intrakranielles Stenting“ in Kombination mit „aggressivem medikamentösem Management“ gegenüber dem „aggressiven medikamentösen Management“ allein (14,7 vs. 5,8 % Schlaganfall oder Tod nach 30 Tagen; p = 0,002) [1]. Auch nach einem Jahr war der endovaskuläre Behandlungsarm noch signifikant unterlegen (20 vs. 12,2 %; p = 0,009). Es handelt sich hier um eine Studie zur Sekundärprophylaxe beim Schlaganfall.


#
 
  • Literatur

  • 1 Chimowitz MI, Lynn MJ, Derdeyn CP et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365: 993-1003
  • 2 Derdeyn CP, Chimowitz MI, Lynn MJ et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 2013; (epub ahead of print)
  • 3 Rothwell P, Warlow C. Is self-audit reliable?. Lancet 1995; 346: 1623
  • 4 Bose A, Hartmann M, Henkes H et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 2007; 38: 1531-1537
  • 5 Turan TN, Maidan L, Cotsonis G et al. Failure of antithrombotic therapy and risk of stroke in patients with symptomatic intracranial stenosis. Stroke 2009; 40: 505-509
  • 6 Lutsep HL, Barnwell SL, Larsen DT et al. Outcome of Patients in the SAMMPRIS Trial Who Had Failed Antithrombotic Therapy at Study Enrollment. International Stroke Conference; 2012 LB5
  • 7 Liebeskind DS, Cotsonis GA, Saver JL et al. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol 2011; 69: 963-974
  • 8 Kim JT, Kim HJ, Yoo SH et al. MRI findings may predict early neurologic deterioration in acute minor stroke or transient ischemic attack due to intracranial atherosclerosis. Eur Neurol 2010; 64: 95-100
  • 9 Derdeyn CP, Fiorella D, Lynn MJ et al. Impact of operator and site experience on outcomes after angioplasty and stenting in the SAMMPRIS trial. J Neurointerv Surg 2013; 6: 528-533
  • 10 Fiorella D, Derdeyn CP, Lynn MJ et al. Detailed analysis of periprocedural strokes in patients undergoing intracranial stenting in Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS). Stroke 2012; 43: 2682-2688