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Lege artis - Das Magazin zur ärztlichen Weiterbildung 2015; 5(1): 26-31
DOI: 10.1055/s-0040-100312
Fachwissen
Titelthema: Akute zerebrale Ischämie
© Georg Thieme Verlag Stuttgart · New York

Akute zerebrale Ischämie – Diagnostik und Therapie

Wolfgang Brunk
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Publication History

Publication Date:
19 February 2015 (online)

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Abstract

Der Patient mit einem akuten Schlaganfall ist als medizinischer Notfall zu behandeln und sollte in eine Schlaganfallstation (Stroke Unit) eingewiesen und dort behandelt werden. Der Schlaganfall ist die dritthäufigste Todesursache, entscheidend für das Outcome der Patienten ist die reibungslose Akuttherapie.Ca. 1/3 der Patienten erreichen eine Klinik im therapierbaren Zeitfenster.Die intravenöse Thrombolyse im akuten Stadium ist eine etablierte und durch große randomisierte Studien validierte Therapie. Die neuen invasiven, interventionellen Techniken zur Thrombektomie sind vielversprechend, der Stellenwert in der Schlaganfalltherapie muss jedoch noch durch randomisierte Studien belegt werden.Dieser Beitrag erläutert, wie Sie einen ischämischen Schlaganfall strukturiert diagnostizieren und behandeln.

Schlüsselwörter:

Schlaganfall - akute zerebrale Ischämie - Therapie - Diagnose - Thrombolyse - Thrombektomie

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  • Literatur

  • 1 Hacke W, Kaste M, Bluhmki E et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359: 1317-1329
    CrossrefPubMedGoogle Scholar
  • 2 Wahlgren N, Ahmed N, Dávalos A et al. Thrombolysis with alteplase 3–4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. Lancet 2008; 372: 1303-1309
    CrossrefPubMedGoogle Scholar
  • 3 National Institutes of Health. NIH Stroke Scale. 2003. Im Internet: http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf dt.Version: http://www.neurologie-wittlich.de/seiten/doku/NIHSS.pdf Stand 0.12.2014
    Google Scholar
  • 4 Keller DM. “MR CLEAN“ polishes stroke outcome with endovascular therapy. Medscape (29.10.2014). Im Internet: http://www.medscape.com/viewarticle/834064 Stand 0.12.2014
    Google Scholar
  • 5 Jüttler E, Bösel J, Amiri H et al. DESTINY II: DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY II. Int J Stroke 2011; 6: 79-86
    CrossrefGoogle Scholar
  • 6 Adams HP, delZoppo G, Alberts MJ et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Resaerch Interdisciplinary Working Groups. Scientific statement from the Stroke Council of the American Stroke Association. Stroke 2007; 38: 1655-1711
    CrossrefPubMedGoogle Scholar
  • 7 Ahmed N, Wahlgren N, Brainin M et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Stroke 2009; 40: 2442-2449
    CrossrefGoogle Scholar
  • 8 Barber PA, Zhang J, Demchuk AM et al. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology 2001; 56: 1015-1020
    CrossrefGoogle Scholar
  • 9 Bergui M, Stura G, Daniele D et al. Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment. Stroke 2006; 37: 145-150
    CrossrefGoogle Scholar
  • 10 Brandt T, von Kummer R, Müller Küppers M et al. Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 1996; 27: 875-881
    CrossrefGoogle Scholar
  • 11 Davalos A, Toni D, Iweins F et al. Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I. Stroke 1999; 30: 2631-2636
    CrossrefGoogle Scholar
  • 12 Diener HC, Weimar C. Leitlinien für Diagnostik und Therapie in der Neurologie. 5. Aufl. Stuttgart: Thieme; 2012
    Article in Thieme ConnectGoogle Scholar
  • 13 Dirks M, Niessen LW, van Wijngaarden JDH et al. Promoting thrombolysis in acute ischemic stroke. Stroke 2011; 42: 1325-1330
    CrossrefPubMedGoogle Scholar
  • 14 Easton JD, Saver JL, Albers GW et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009; 40: 2276-2293
    CrossrefGoogle Scholar
  • 15 Giles MF, Albers GW, Amarenco P et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study. Neurology 2011; 77: 1222-1228
    CrossrefGoogle Scholar
  • 16 Gupta R, Connolly ES, Mayer S et al. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 2004; 35: 539-543
    CrossrefGoogle Scholar
  • 17 Hacke W, Donnan G, Fieschi C et al. Association of outcome with early stroke treatment: Pooled analysis of atlantis, ecass, and nindsrt-pa stroke trials. Lancet 2004; 363: 768-774
    CrossrefPubMedGoogle Scholar
  • 18 Jüttler E, Schwab S, Schmiedek P et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 2007; 38: 2518-2525
    CrossrefPubMedGoogle Scholar
  • 19 Lees KR, Bluhmki E, Kummer von R et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375: 1695-1703
    CrossrefGoogle Scholar
  • 20 Mattle HP, Arnold M, Lindsberg PJ et al. Basilar artery occlusion. Lancet Neurol 2011; 10: 1002-1014
    CrossrefPubMedGoogle Scholar
  • 21 Nakano S, Iseda T, Yoneyama T et al. Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombolysis. Stroke 2002; 33: 2872-2876
    CrossrefGoogle Scholar
  • 22 National Institute of Neurological Disorders and Stroke (NINDS). Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke 1996. Im Internet: http: //www.ninds.nih.gov/news_and_events/proceedings/stroke_proceedings/recs-acute.htm Stand 0.12.2014
    Google Scholar
  • 23 Nogueira RG, Lutsep HL, Gupta R et al. Trevo versus Merci retrievers for thrombectomyrevascularisation of large vessel occlusions in acute ischaemic stroke (TREVOR 2): a randomised trial. Lancet 2012; 380: 1231-1240
    CrossrefPubMedGoogle Scholar
  • 24 Penumbra Pivotal Stroke Trial Investigators. The Penumbra Pivotal Stroke Trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 2009; 40: 2761-2768
    CrossrefGoogle Scholar
  • 25 Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a metaanalysis. Stroke 2007; 38: 967-973
    CrossrefPubMedGoogle Scholar
  • 26 Rimmele L, Thomalla G. Wake-up Stroke: clinical characteristics, imaging findings and treatment option – an update. Front Neurol 2014; 5: 35-35
    Google Scholar
  • 27 Saver JL, Jahan R, Levy El et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 2012; 380: 1241-1249
    CrossrefPubMedGoogle Scholar
  • 28 Stampfl S, Hartmann M, Ringleb PA et al. Stent placement for flow restoration in acute ischemic stroke; a single-center experience with the Solitaire stent system. AJNR Am J Neuroradiol 2011; 32: 1245-1248
    CrossrefGoogle Scholar
  • 29 Stroke Unit Trialists' Collaboration. Organized inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev CD 000197 2007; 4
    Google Scholar
  • 30 Thomalla G, Cheng B, Ebinger M et al. DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4,5 h of symptom onset (PRE-FLAIR): a multicentre observational study. Lancet Neurol 2011; 10: 978-986
    CrossrefGoogle Scholar
  • 31 Uhl E, Kreth FW, Elias B et al. Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction. JNNP 2004; 75: 270-274
    Google Scholar
  • 32 Wahlgren N, Ahmed N, Dávalos A et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007; 369: 275-282
    CrossrefPubMedGoogle Scholar