Insult

Abstract

A stroke is usually caused by ischaemia, less frequently by an intracerebral hemorrhage. The distinction between hemorrhagic and ischaemic strokes, as well as the identification of patients requiring immediate recanalization therapy, cannot be made by clinical examination but requires CT imaging. In most patients with an ischemic stroke, large parts of the affected brain area are functionless throughout the first hours, but not yet irreversibly damaged (penumbra tissue). These areas can be saved through early vessel recanalization. In the acute phase of ischaemic stroke, a delay of 15 minutes results in a significant worsening of the neurologic prognosis.

With modern endovascular techniques, even patients with the most severe ischemic strokes have a fair chance of neurological recovery, if they are admitted to a specialised centre within the first few hours.

Ein Insult oder Schlaganfall bezeichnet einen plötzlichen Verlust einer ZNS-Funktion, der länger als 24 Stunden anhält. Durch die Einführung der modernen Katheterverfahren hat sich die Schlaganfalltherapie in den letzten Jahren erheblich geändert. Heute haben auch Patienten mit schwersten ischämischen Schlaganfällen noch eine Chance auf eine neurologische Erholung, wenn sie innerhalb der ersten Stunden ein spezialisiertes Zentrum erreichen.

Schlüsselwörter

Schlaganfall - Hirnblutung - Hirninfarkt - mechanische Thrombektomie

Key words

stroke - intracerebral hemorrhage - ischemic infarction - endovascular thrombectomy

• Literatur

• 1 Wiesmann M, Bohner G, Klingebiel R. Zerebrale Perfusionsbildgebung mittels Mehrschichtspiral-CT. Clin Neuroradiol 2004; 14: 92-107
• 2 Adams HP, Bendixen BH, Kappelle LJ. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41
• 3 Linn J, Wiesmann M, Brückmann H. Atlas Klinische Neuroradiologie des Gehirns. Heidelberg: Springer; 2011
• 4 Lozano R, Naghavi M, Foreman K. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095-2128
• 5 Heldner MR, Zubler C, Mattle HP. et al. National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke. Stroke 2013; 44: 1153-1157
• 6 Wardlaw JM, Murray V, Berge E. et al. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2014; 7: CD000213
• 7 Berkhemer OA, Fransen PS, Beumer D. et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11-20
• 8 Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007; 38: 967-973
• 9 Riedel CH, Zimmermann P, Jensen-Kondering U. et al. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke 2011; 42: 1775-1777
• 10 Spiotta AM, Chaudry MI, Hui FK. et al. Evolution of thrombectomy approaches and devices for acute stroke: a technical review. J Neurointerv Surg 2015; 7: 2-7
• 11 Wiesmann M, Brockmann MA, Heringer S. et al. Active push deployment technique improves stent/vessel-wall interaction in endovascular treatment of acute stroke with stent retrievers. J Neurointervent Surg 2017; 9: 253-256
• 12 Nikoubashman O, Alt P, Nikoubashman A. et al. Optimizing endovascular stroke treatment: Removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow. J Neurointerv Surg 2017; 9: 459-462
• 13 Saver JL, Fonarow GC, Smith EE. et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA 2013; 309: 2480-2488
• 14 Sheth SA, Jahan R, Gralla J. et al. Time to endovascular reperfusion and degree of disability in acute stroke. Ann Neurol 2015; 78: 584-593
• 15 Nikoubashman O, Pauli F, Schürmann K. et al. Transfer of stroke patients impairs eligibility for endovascular stroke treatment. J Neuroradiol 2018; 45: 49-53
• 16 Nikoubashman O, Schürmann K, Othman AE. et al. Improvement of endovascular stroke treatment: A 24-hour neuroradiological on-site service is not enough. Biomed Res Int 2018; 2018: 9548743. doi:10.1155/2018/9548743
• 17 Kasner SE. Clinical interpretation and use of stroke scales. Lancet Neurol 2006; 5: 603-612