Neuroradiologische Diagnostik und Therapie von zerebralen Vasospasmen nach Subarachnoidalblutung

Zusammenfassung

Hintergrund Die zerebrale Schädigung nach einer aneurysmatischen Subarachnoidalblutung (SAB) entsteht aus verschiedenen, teils unverbundenen Ursachen. Nach dem initialen Blutungstrauma mit Anstieg des intrakraniellen Drucks kann es im Verlauf zu einer induzierten Vasokonstriktion, aber auch zu Störungen der Mikrozirkulation, Inflammationen und pathologischen elektrophysiologischen Vorgängen (kortikale Streudepolarisation) mit der Folge einer verzögerten zerebralen Ischämie (= Delayed cerebral ischemia [DCI]) kommen. Im neuroradiologischen Kontext bleiben zerebrale Vasospasmen (ZVS) als häufiger Bestandteil der Genese von DCI im Fokus der bildgebenden Diagnostik und endovaskulären Therapie.

Methode Die Menge des bei der Aneurysmaruptur ausgetretenen Blutes (die z. B. durch das CT erfasst werden kann) korreliert mit Auftreten und Ausprägung von ZVS. Die CT-Perfusion ist dann ein wichtiger Baustein für die Indikationsstellung zu endovaskulären Spasmustherapien (EST). Diese beinhalten intraarterielle Medikamentengaben (auch als Mikrokatheterdauerbehandlung) und mechanische Verfahren (Ballonangioplastie, Gefäßerweiterungen durch andere Instrumente wie z. B. Stentretreiver, Stenting).

Schlussfolgerung Die vorliegende Übersichtsarbeit stellt aus neuroradiologischer Sicht die gegenwärtigen Erkenntnisse zur Diagnostik und Therapie von ZVS nach aneurysmatischer SAB unter Berücksichtigung einer insgesamt komplexen und dabei auch der aktuellsten internationalen Literatur zusammen.

Kernaussagen

• Vasospasmen sind häufiger Bestandteil der multifaktoriellen Genese von verzögerten zerebralen Ischämien nach SAB und bleiben im neuroradiologischen Kontext Fokus von Diagnostik und Therapie.

• Das initiale Ausmaß der SAB im CT ist mit dem Auftreten und der Schwere von Vasospasmen assoziiert.

• Die CT-Perfusion ist ein wichtiger Baustein für die Indikationsstellung zur endovaskulären Spasmustherapie.

• Endovaskuläre Spasmustherapien beinhalten lokale Medikamentengaben (auch als Dauertherapien mit Mikrokathetern) und mechanische Verfahren (Ballonangioplastie, Dilatationen durch andere Devices wie z. B. Stentretreiver, Stenting).

Zitierweise

• Neumann A, Schacht H, Schramm P. Neuroradiological diagnosis and therapy of cerebral vasospasm after subarachnoid hemorrhage. Fortschr Röntgenstr 2024; 196: 1125 – 1133

Keywords

subarachnoid hemorrhage - delayed cerebral ischemia - cerebral vasospasm - endovascular rescue treatment - nimodipine - balloon angioplasty

Publication History

Received: 29 November 2023

Accepted after revision: 30 January 2024

Article published online:
13 March 2024

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