Was gibt es Neues beim Schlaganfall?

Zusammenfassung

Anhand von selektierten Publikationen aus den vergangenen 12 Monaten werden aktuelle Entwicklungen und Neuheiten in der Prävention und Behandlung des Schlaganfalls dargestellt. In der Primärprävention ist die Kombination eines ACE-Hemmers und eines Kalziumantagonisten wirksamer als die Kombination eines ACE-Hemmers mit einem Diuretikum. Bei Patienten mit Diabetes mellitus ist niedrig dosiertes ASS in der Primärprävention makrovaskulärer Ereignisse nicht wirksam. Eine aggressive Behandlung des Diabetes mellitus Typ II reduziert mikrovaskuläre Ereignisse, führt aber nicht zu einer Reduktion von Herzinfarkt, Schlaganfall oder vaskulärem Tod. Die Sicherheit und Effektivität der systemische Thrombolyse mit rt-PA konnte auch in dem erweiterten Zeitfenster zwischen 3–4,5 h nach ischämischem Schlaganfall nachgewiesen werden. Es gibt Hinweise, dass eine Komedikation mit Omeprazol zu einer Abschwächung der Clopidogrelwirkung führt. Bei Patienten mit Vorhofflimmern, die Kontraindikationen gegen die orale Antikoagulation haben oder diese ablehnen, ist eine Kombinationstherapie aus Clopidogrel und ASS der ASS-Monotherapie überlegen. Die Kombinationstherapie ASS und Clopidogrel ist jedoch mit einem eindeutig erhöhten Blutungsrisiko in der Schlaganfallsekundärprophylaxe verbunden. Aufgrund der Langzeitergebnisse bleibt die Karotisendarteriektomie bei > 70 %igen symptomatischen Karotisstenosen die Therapie der 1. Wahl und kann sowohl in Lokalanästhesie als auch in Allgemeinnarkose durchgeführt werden.

Abstract

On the basis of selected publications from the past 12 months, current developments and innovations in the prevention and treatment of stroke are presented. For primary prevention, the combination of an ACE inhibitor and a calcium antagonist has proved to be more effective than the combination of an ACE inhibitor with a diuretic. For patients with diabetes mellitus low-dose ASA is not effective for the primary prevention of macrovascular events. Aggressive treatment of diabetes mellitus type II reduces microvascular events but does not lead to a reduction in heart attack, stroke or vascular mortality. The safety and efficacy of systemic thrombolysis with rt-PA has also been demonstrated in the expanded time window of 3 to 4.5 hours after ischaemic stroke. There are indications that a comedication with omeprazol can lead to a reduction of the effects of clopidogrel. In patients with atrial fibrillation, those with contraindications against an oral anticoagulation, or those who reject the latter therapy, the combination of clopidogrel with ASA is superior to an ASA monotherapy. However, the combination therapy of ASA with clopidogrel is associated with a markedly higher bleeding risk in the secondary prophylaxis of stroke. On the basis of long-term results, carotid endarterectomy is the treatment of first choice in cases of symptomatic > 70 % carotid stenosis and can be performed either under local anaesthesia or under general anaesthesia.

Schlüsselwörter

Schlaganfall - Prävention - klinische Studien

Keywords

stroke - prevention - clinical trials

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