Reith Wolfgang, Yilmaz Umut, Haußmann Alena
Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland.
Radiologie (Heidelb). 2024 Sep;64(9):724-727. doi: 10.1007/s00117-024-01354-5. Epub 2024 Aug 21.
Proximal carotid tandem lesions are defined as multilevel lesions with significant (> 50%) atherosclerotic disease involving the internal carotid artery (ICA) in combination with the proximal ipsilateral common carotid artery (CCA) or innominate artery (IA). It is a relatively rare disease with an incidence of less than 5% in all patients with carotid stenosis at the level of the bifurcation.
These patients are at high surgical risk and were, therefore, excluded from current randomized controlled trials. Although the effectiveness of carotid endarterectomy (CEA) and carotid stenting (CAS) in stroke prevention for patients is established, the optimal treatment approach for the subgroup of patients with a proximal tandem lesion is still controversial. Treatment of this condition is not well understood because it is difficult to determine the risk of each individual lesion becoming symptomatic. Therefore, concurrent treatment of severe (> 70% stenosis) proximal lesions is recommended when treating severe stenosis at the carotid bifurcation.
This disease can lead to embolic ischemic strokes or hemodynamic compromise. It is not possible to determine diagnostically which lesion led to the clinical symptoms, which is why both lesions should be corrected.
近端颈动脉串联病变被定义为多节段病变，伴有累及颈内动脉（ICA）并合并同侧近端颈总动脉（CCA）或无名动脉（IA）的显著（>50%）动脉粥样硬化疾病。它是一种相对罕见的疾病，在所有分叉水平的颈动脉狭窄患者中发病率低于5%。
这些患者手术风险高，因此被排除在当前的随机对照试验之外。尽管颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）对患者预防卒中的有效性已得到确立，但对于近端串联病变亚组患者的最佳治疗方法仍存在争议。由于难以确定每个病变出现症状的风险，因此对这种情况的治疗尚不清楚。因此，在治疗颈动脉分叉处的严重狭窄时，建议同时治疗严重（>70%狭窄）的近端病变。
这种疾病可导致栓塞性缺血性卒中或血流动力学损害。无法通过诊断确定是哪个病变导致了临床症状，这就是为什么两个病变都应得到纠正的原因。
