Behandlung der Aortenisthmusstenose bei Erwachsenen – Update 2020

Die Aortenisthmusstenose ist eine angeborene Verengung der Aorta, deren Diagnose häufig erst im Erwachsenenalter gestellt wird. Die Langzeitprognose der Patienten wird durch die Folgen der arteriellen Hypertonie, der Gefahr einer Aortenruptur und/oder Ausbildung von Aneurysmen bestimmt. Die endovaskuläre Therapie dieser Erkrankung hat sich in den letzten Jahren zum Standardverfahren an größeren Zentren entwickelt.

Kernaussagen

• Die Aortenisthmusstenose ist mit 5 – 8% aller kongenitalen kardiovaskulären Fehlbildungen relativ häufig.

• Eine Aortenisthmusstenose geht mit reduzierter Lebenserwartung einher, wenn sie nicht beseitigt wird. Fortbestehender Hypertonus kann zu zerebralen Ereignissen und zur linksventrikulären Hypertrophie und Entwicklung einer Herzinsuffizienz führen; es kommt zu extensiven Kollateralneubildungen.

• Erfolgreich ist eine Behandlung, wenn es zum Blutdruckangleich beiderseits der Stenose kommt.

• Das klassische chirurgische Verfahren ist von endovaskulären Verfahren abgelöst worden, mit denen sich vergleichbare Ergebnisse erreichen lassen bei deutlich geringerem Risiko.

• Das chirurgische Trauma und eventuelle Blutungskomplikationen angesichts des ausgedehnten Kollateralnetzes werden vermieden durch ballonexpandierbare oder selbstexpandierende Stents oder Stentgrafts.

• Der therapeutische Paradigmenwechsel zugunsten eines nicht chirurgischen Verfahrens wird von der aktuellen Datenlage unterstützt.

Schlüsselwörter

Aortenisthmusstenose - Coarctatio aortae - interventionelle Therapie

Publication History

Article published online:
08 December 2020

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