Akuttherapie des Schlaganfalls

R. Stingele; Ch. C. Eschenfelder; J. Zeller

doi:10.1055/s-0037-1616977

Hämostaseologie, Table of Contents

Hamostaseologie 2006; 26(04): 316-325
DOI: 10.1055/s-0037-1616977

Research Articles

Schattauer GmbH

Akuttherapie des Schlaganfalls

Therapy of acute stroke

Authors

R. Stingele

¹Klinik für Neurologie (Direktor: Prof. Dr. med. Günther Deuschl), Universitätsklinikum Schleswig- Holstein, Campus Kiel
Ch. C. Eschenfelder

¹Klinik für Neurologie (Direktor: Prof. Dr. med. Günther Deuschl), Universitätsklinikum Schleswig- Holstein, Campus Kiel
J. Zeller

¹Klinik für Neurologie (Direktor: Prof. Dr. med. Günther Deuschl), Universitätsklinikum Schleswig- Holstein, Campus Kiel

Abstract

Zusammenfassung

Die aktuellen Konzepte zur Behandlung der akuten zerebralen Ischämie sowie der Hirnblutung werden dargestellt. Die Indikationsstellung zur Thrombolyse im Standardfall und in besonderen Situationen, die Anwendung moderner MRT-Diagnostik und differenzialtherapeutische Überlegungen werden dargelegt. Bei der Therapie der Hirnblutung wird auf die Indikationsstellung zur neurochirurgischen Hämatomevakuation eingegangen und die akute hämostatische Therapie besprochen.

Summary

Current therapeutic concepts for acute cerebral ischaemia and cerebral haemorrhage are summarized. Patient selection for thrombolysis, the role of stroke MRI and the choice of recanalization techniques are discussed. The treatment of intracerebral haemorrhage with particular emphasis on evacuation of haematoma and acute haemostatic therapy are discussed.

Schlüsselwörter

Ischämie - Hirnblutung - Thrombolyse - Bridging - Rekanalisation - Neuroprotektion

Keywords

Cerebral ischaemia - cerebral haemorrhage - thrombolysis - bridging - recanalisation - neuroprotection

Full Text

References

Literatur
1 Tissue plasminogen activator for acute ischemic stroke.. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995; 333: 1581-7.
2 Thrombolytic therapy with streptokinase in acute ischemic stroke.. The Multicenter Acute Stroke Trial - Europe Study Group. N Engl J Med 1996; 335: 145-50.
3 Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke.. The NINDS t-PA Stroke Study Group. Stroke 1997; 28: 2109-18.
4 Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization.. The EPILOG Investigators. N Engl J Med 1997; 336: 1689-96.
5 A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina.. Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Study Investigators. N Engl J Med 1998; 338: 1498-505.
6 Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non- Q-wave myocardial infarction.. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. N Engl J Med 1998; 338: 1488-97.
7 Randomised placebo-controlled and balloon-angioplasty- controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/ IIIa blockade.. The EPISTENT Investigators. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. Lancet 1998; 352 9122 87-92.
8 Abciximab in acute ischemic stroke: a randomized, double-blind, placebo-controlled, dose-escalation study.. The Abciximab in Ischemic Stroke Investigators. Stroke 2000; 31: 601-9.
9 Alexandrov AV, Demchuk AM, Felberg RA. et al. High rate of complete recanalization and dramatic clinical recovery during tPA infusion when continuously monitored with 2-MHz transcranial doppler monitoring. Stroke 2000; 31: 610-4.
10 Alexandrov AV, Wojner AW, Grotta JC. CLOTBUST: design of a randomized trial of ultrasoundenhanced thrombolysis for acute ischemic stroke. J Neuroimaging 2004; 14: 108-12.
11 Arkin S, Cooper HA, Hutter JJ. et al. Activated recombinant human coagulation factor VII therapy for intracranial hemorrhage in patients with hemophilia A or B with inhibitors. Results of the novoseven emergency-use program. Haemostasis 1998; 28: 93-8.
12 Astrup J, Siesjo BK, Symon L. Thresholds in cerebral ischemia – the ischemic penumbra. Stroke 1981; 12: 723-5.
13 Baird TA, Parsons MW, Phanh T. et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke 2003; 34: 2208-14.
14 Behrens S, Daffertshofer M, Spiegel D. et al. Lowfrequency, low-intensity ultrasound accelerates thrombolysis through the skull. Ultrasound Med Biol 1999; 25: 269-73.
15 Bertram M, Bonsanto M, Hacke W. et al. Managing the therapeutic dilemma: patients with spontaneous intracerebral hemorrhage and urgent need for anticoagulation. J Neurol 2000; 247: 209-14.
16 Broderick JP, Brott TG, Duldner JE. et al. Volume of intracerebral hemorrhage. A powerful and easy- to-use predictor of 30-day mortality. Stroke 1993; 24: 987-93.
17 Brott T, Broderick J, Kothari R. et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28: 1-5.
18 Bruno A, Levine SR, Frankel MR. et al. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology 2002; 59: 669-74.
19 Cheng YD, Al-Khoury L, Zivin JA. Neuroprotection for ischemic stroke: two decades of success and failure. NeuroRx 2004; 1: 36-45.
20 Clark WM, Wissman S, Albers GW. et al. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999; 282: 2019-26.
21 Daffertshofer M, Gass A, Ringleb P. et al. Transcranial low-frequency ultrasound-mediated thrombolysis in brain ischemia: increased risk of hemorrhage with combined ultrasound and tissue plasminogen activator: results of a phase II clinical trial. Stroke 2005; 36: 1441-6.
22 Derex L, Nighoghossian N, Hermier M. et al. Thrombolysis for ischemic stroke in patients with old microbleeds on pretreatment MRI. Cerebrovasc Dis 2004; 17: 238-41.
23 Eckert B, Koch C, Thomalla G. et al. Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke 2005; 36: 1160-5.
24 Eckert B, Koch C, Thomalla G. et al. Acute basilar artery occlusion treated with combined intravenous Abciximab and intra-arterial tissue plasminogen activator: report of 3 cases. Stroke 2002; 33: 1424-7.
25 Eggers J, Koch B, Meyer K. et al. Effect of ultrasound on thrombolysis of middle cerebral artery occlusion. Ann Neurol 2003; 53: 797-800.
26 Ernst R, Pancioli A, Tomsick T. et al. Combined intravenous and intra-arterial recombinant tissue plasminogen activator in acute ischemic stroke. Stroke 2000; 31: 2552-7.
27 Fernandes HM, Gregson B, Siddique S. et al. Surgery in intracerebral hemorrhage. The uncertainty continues. Stroke 2000; 31: 2511-6.
28 Furlan A, Higashida R, Wechsler L. et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999; 282: 2003-11.
29 Furlan AJ, Whisnant JP, Elveback LR. The decreasing incidence of primary intracerebral hemorrhage: a population study. Ann Neurol 1979; 5: 367-73.
30 Gardell SJ, Ramjit DR, Stabilito II. et al. Effective thrombolysis without marked plasminemia after bolus intravenous administration of vampire bat salivary plasminogen activator in rabbits. Circulation 1991; 84: 244-53.
31 Gregson BA, Mendelow AD. International variations in surgical practice for spontaneous intracerebral hemorrhage. Stroke 2003; 34: 2593-7.
32 Hacke W, Albers G, Al Rawi Y. et al. The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 2005; 36: 66-73.
33 Hacke W, Donnan G, Fieschi C. et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt- PA stroke trials. Lancet 2004; 363 9411 768-74.
34 Hacke W, Kaste M, Fieschi C. et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017-25.
35 Hacke W, Kaste M, Fieschi C. et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European- Australasian Acute Stroke Study Investigators. Lancet 1998; 352 9136 1245-51.
36 Haley Jr EC, Lyden PD, Johnston KC. et al. A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke. Stroke 2005; 36: 607-12.
37 Heuschmann PU, Kolominsky-Rabas PL, Roether J. et al. Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy. JAMA 2004; 292: 1831-8.
38 Huynh T, Theroux P, Snapinn S. et al. Effect of platelet glycoprotein IIb/IIIa receptor blockade with tirofiban on adverse cardiac events in women with unstable angina/non-ST-elevation myocardial infarction (PRISM-PLUS Study). Am Heart J 2003; 146: 668-73.
39 Junghans U, Seitz RJ, Wittsack HJ. et al. Treatment of acute basilar artery thrombosis with a combination of systemic alteplase and tirofiban, a nonpeptide platelet glycoprotein IIb/IIIa inhibitor: report of four cases. Radiology 2001; 221: 795-801.
40 Kidwell CS, Saver JL, Villablanca JP. et al. Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application. Stroke 2002; 33: 95-8.
41 Koennecke HC. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology 2006; 66: 165-71.
42 Labiche LA, Al Senani F, Wojner AW. et al. Is the benefit of early recanalization sustained at 3 months? A prospective cohort study. Stroke 2003; 34: 695-8.
43 Langhorne P, Dennis MS. Stroke units: the next 10 years. Lancet 2004; 363 9412 834-5.
44 Liberatore GT, Samson A, Bladin C. et al. Vampire bat salivary plasminogen activator (desmoteplase): a unique fibrinolytic enzyme that does not promote neurodegeneration. Stroke 2003; 34: 537-43.
45 Mayer SA, Brun NC, Begtrup K. et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2005; 352: 777-85.
46 Mendelow AD, Gregson BA, Fernandes HM. et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005; 365 9457 387-97.
47 Molina CA, Alvarez-Sabin J, Montaner J. et al. Thrombolysis-related hemorrhagic infarction: a marker of early reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke 2002; 33: 1551-6.
48 Molina CA, Ribo M, Rubiera M. et al. Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke 2006; 37: 425-9.
49 Multicentre Acute Stroke Trial – Italy (MAST-I) Group.. Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 1995; 346 8989 1509-14.
50 Parsons MW, Barber PA, Desmond PM. et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol 2002; 52: 20-8.
51 Reith J, Jorgensen HS, Pedersen PM. et al. Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 1996; 347 8999 422-5.
52 Schmulling S, Grond M, Rudolf J. et al. One-year follow-Up in acute stroke patients treated with rtPA in clinical routine. Stroke 2000; 31: 1552-4.
53 Schomig A, Kastrati A, Dirschinger J. et al. Coronary stenting plus platelet glycoprotein IIb/ IIIa blockade compared with tissue plasminogen activator in acute myocardial infarction. Stent versus Thrombolysis for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Study Investigators. N Engl J Med 2000; 343: 385-91.
54 Sehgal CM, Leveen RF, Shlansky-Goldberg RD. Ultrasound-assisted thrombolysis. Invest Radiol 1993; 28: 939-43.
55 Seitz RJ, Hamzavi M, Junghans U. et al. Thrombolysis with recombinant tissue plasminogen activator and tirofiban in stroke: preliminary observations. Stroke 2003; 34: 1932-5.
56 Stone GW, Grines CL, Cox DA. et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 2002; 346: 957-66.
57 Straub S, Junghans U, Jovanovic V. et al. Systemic thrombolysis with recombinant tissue plasminogen activator and tirofiban in acute middle cerebral artery occlusion. Stroke 2004; 35: 705-9.
58 Stroke Unit Trialists’ Collaboration.. Organised inpatient (stroke unit) care for stroke. The Cochrane Database of Systematic Reviews 2001; 3: CD000197.
59 Sulter G, Elting JW, Langedijk M. et al. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit: a randomized pilot study. Stroke 2003; 34: 101-4.
60 The Multicenter Acute Stroke Trial – Europe Study Group.. Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med 1996; 35: 45-50.
61 Thom T, Haase N, Rosamond W. et al. Heart disease and stroke statistics – 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006; 113: e85-151.
62 Thomalla G, Schwark C, Sobesky J. et al. Outcome and Symptomatic Bleeding Complications of Intravenous Thrombolysis Within 6 Hours in MRISelected Stroke Patients: Comparison of a German Multicenter Study With the Pooled Data of ATLANTIS, ECASS, and NINDS tPA Trials. Stroke 2006; 37: 852-8.
63 Toni D, Chamorro A, Kaste M. et al. Acute treatment of ischaemic stroke. European Stroke Initiative. Cerebrovasc Dis 2004; 17 (Suppl. 02) 30-46.
64 Topol EJ, Moliterno DJ, Herrmann HC. et al. Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization. N Engl J Med 2001; 344: 1888-94.
65 Weir CJ, Murray GD, Dyker AG. et al. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. Br Med J 1997; 314: 1303-6.