Stent angioplasty

The term stent angioplasty stands for an angioplasty in which a stent is implanted into the treated blood vessel . This method is used when angioplasty alone does not lead to sufficient openness of the vessel or it is known that the rate of restenoses is significantly increased without additional stent implantation . The stent counteracts reclosure due to the elastic restoring forces ('recoil') of the vessel. Wall injuries ( dissections ) can also be treated with this procedure. The stent can be placed either directly during or after an angioplasty. If the stent is used immediately as an emergency treatment for an occlusion caused by dissection or a vascular rupture, it is called a bail-out stenting .

Carotid tentangioplasty

The first experimental animal experiments on the treatment of stenoses using vascular prostheses were published in 1983. The first carotid artery angioplasty was performed in 1979 . A narrowing due to fibromuscular dysplasia was treated. In 1987 a stent angioplasty was performed on a pelvic artery for the first time.

In 1987 the first cerebral protection systems were developed. These are filters that are released above the constriction during treatment in order to prevent cerebral embolism , the blood flow to the brain is maintained. Another method is balloon occlusion, which is performed either above or below the stenosis. This interrupts the flow of blood to the brain.

The technical success rate, which includes successful passage and release of the stent material, is 94-99%. The peri- and post-procedural rate for simultaneous strokes and death within the first 30 days after the intervention is 1.6–7.4% and is thus comparable to surgical treatment. However, future studies will have to show whether the high technical and financial outlay means a real improvement in patient care compared to conventional carotid surgery. Until then, this intervention should be viewed as an experimental procedure.

Subclavian tangioplasty

For central stenoses of the subclavian artery , balloon angioplasty is the method of choice. The success rates are just as high as with a stent angioplasty, despite significantly less effort. The latter is only indicated for occlusion, for long stenoses that are difficult to define, for hemodynamically significant restenoses or for a dissection.

In the case of stenoses of the subclavian artery in the area of the intersection of the clavicle - first rib, stenting is contraindicated and pure angioplasty is contraindicated without long-term success. In the case of stenoses in the area of the crossover between the clavicle and the first rib, one speaks of a thoracic outlet syndrome (TOS), in this case an arterial thoracic outlet syndrome (aTOS), and the treatment of choice is the corresponding degree of severity such as stenosis Subclavian artery surgical removal of the 1st rib. After removal of the 1st rib, an open or interventional treatment of the stenosis can be carried out if the stenosis remains, whereby the access for an open treatment is already given by the removal of the 1st rib and thus the vessel is already exposed. In this respect, as part of the removal of the 1st rib, a short interposition can also be placed, for example.

Individual evidence

↑ ^a ^b ^c Ulf Teichgräber, René Aschenbach, Dierk Scheinert, Andrej Schmidt: Peripheral arterial interventions: practical book for radiology and angiology . Springer, Berlin 2018, ISBN 9783662559352 , p. 198.
↑ D. Hahn, Jürgen Freyschmidt: manual diagnostic radiology: Cardiovascular System . Springer, Berlin 2007, ISBN 978-3-540-69018-4 , p. 360.
↑ Rainer Knur: Cerebral protection in carotid tangioplasty: technology, use and necessity. In: cardiologist . Volume 3, 2009, pp. 220-227, doi: 10.1007 / s12181-009-0169-2 .
^ HH Eckstein, P. Ringleb, JR Allenberg, J. Berger, G. Fraedrich, W. Hacke, M. Hennerici, R. Stingele, J. Fiehler, H. Zeumer, O. Jansen: Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomized trial. In: The Lancet Neurology . Volume 7, No. 10, 2008, pp. 893-902, ISSN 1474-4422 . doi : 10.1016 / S1474-4422 (08) 70196-0 . PMID 18774746 .
↑ H.-H. Eckstein, L. Sunder-Plassmann: Endovascular versus conventional vascular surgery: interim balance and position determination . Springer, Berlin 2013, ISBN 978-3-662-26791-2 , p. 124.
↑ H.-H. Eckstein, L. Sunder-Plassmann: Endovascular versus conventional vascular surgery: interim balance and position determination . Springer, Berlin 2013, ISBN 978-3-662-26791-2 , p. 110.

[Teichgräber198-1] Ulf Teichgräber, René Aschenbach, Dierk Scheinert, Andrej Schmidt: Peripheral arterial interventions: practical book for radiology and angiology . Springer, Berlin 2018, ISBN 9783662559352 , p. 198.

[2] D. Hahn, Jürgen Freyschmidt: manual diagnostic radiology: Cardiovascular System . Springer, Berlin 2007, ISBN 978-3-540-69018-4 , p. 360.

[3] Rainer Knur: Cerebral protection in carotid tangioplasty: technology, use and necessity. In: cardiologist . Volume 3, 2009, pp. 220-227, doi: 10.1007 / s12181-009-0169-2 .

[PMID18774746-4] HH Eckstein, P. Ringleb, JR Allenberg, J. Berger, G. Fraedrich, W. Hacke, M. Hennerici, R. Stingele, J. Fiehler, H. Zeumer, O. Jansen: Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomized trial. In: The Lancet Neurology . Volume 7, No. 10, 2008, pp. 893-902, ISSN 1474-4422 . doi : 10.1016 / S1474-4422 (08) 70196-0 . PMID 18774746 .

[5] H.-H. Eckstein, L. Sunder-Plassmann: Endovascular versus conventional vascular surgery: interim balance and position determination . Springer, Berlin 2013, ISBN 978-3-662-26791-2 , p. 124.

[6] H.-H. Eckstein, L. Sunder-Plassmann: Endovascular versus conventional vascular surgery: interim balance and position determination . Springer, Berlin 2013, ISBN 978-3-662-26791-2 , p. 110.