Trotz weiterentwickelter Therapieverfahren erleiden heute weltweit nach wie vor mehr
als 10 Millionen Menschen pro Jahr einen Schlaganfall. Diese Übersichtsarbeit fasst
neue Erkenntnisse zur Epidemiologie, Diagnostik, Akuttherapie sowie Primär- und Sekundärprävention
des Schlaganfalls aus den Jahren 2015 und 2016 zusammen.
Abstract
This review summarizes new findings on epidemiology, diagnosis, acute therapy, primary
and secondary prevention of stroke published in 2015 and 2016. Recent epidemiological
studies show that treatable risk factors such as hypertension, diabetes mellitus,
smoking, physical inactivity, nutrition and stress can explain 90 % of stroke risk.
In patients with asymptomatic high degree carotid stenosis, stenting has a similar
complication rate as endarterectomy. New randomised studies and results from large-scale
registries indicate that systemic thrombolysis of acute ischemic stroke can be safely
performed in more patients than originally labelled for. This applies to patients > 80
years, with severe strokes or with systolic blood pressure values > 160 mmHg. Patients
with dissection of brain supplying arteries also benefit from thrombolysis. In patients
treated with non-vitamin-K dependent oral anticoagulants (NOAC) for stroke prevention
in atrial fibrillation (AF), thrombolysis can be performed if the last intake was
ago long enough that coagulation parameters are normal. The most effective treatment
of acute occlusions of the distal internal carotid artery and the proximal middle
cerebral artery is systemic thrombolysis with rt-PA followed by mechanical thrombectomy
with a stent-retriever (number needed to treat = 2.6 for good functional outcome).
In patients with mild to moderate ischemic stroke or high-risk TIA, ticagrelor was
not superior to aspirin in the prevention of recurrent stroke, MI or vascular death.
However, ticagrelor was superior to aspirin in preventing recurrent ischemic stroke.
In patients with acute cerebral haemorrhage and high blood pressure, lowering of blood
pressure has only minor efficacy. In patients with vitamin-K antagonist related intracerebral
haemorrhage, Prothrombin complex concentrate (PPSB) is more effective than fresh frozen
plasma (FFP). Occlusion of patent foramen ovale in patients with cryptogenic stroke
should be restricted to selected cases.
Schlüsselwörter
Schlaganfall - Prävention - Akuttherapie - zerebrale Blutung - offenes Foramen ovale
Keywords
stroke - prevention - acute therapy - cerebral haemorrhage - patent foramen ovale
