Therapie des akuten ischämischen Schlaganfalls

ZUSAMMENFASSUNG

Die Behandlungsmöglichkeiten des akuten ischämischen Schlaganfalls haben sich durch Weiterentwicklung bewährter und Erprobung neuer Therapieansätze in den letzten Jahren verbessert. Durch den Einsatz der erweiterten Akutbildgebung mittels multimodaler Computer- oder Magnetresonanztomografie konnte der Zugang zu Thrombolyse und Thrombektomie auch für ausgewählte Patienten mit unbekanntem oder bis zu 9 bzw. 24 h zurückliegendem Beginn der akuten Schlaganfallsymptomatik ermöglicht werden. Ergänzend zu diesen rekanalisierenden Akuttherapien zeigen adjuvante neuroprotektive und immunmodulatorische Behandlungsansätze vielversprechende Ergebnisse. Schließlich gewinnen eine verbesserte Zusammenarbeit der an der Schlaganfallversorgung beteiligten Fachdisziplinen und die Optimierung logistischer Prozesse an Bedeutung, um den zeitabhängigen Nutzen der Akuttherapie individuell zu maximieren. Der vorliegende Artikel fasst wesentliche aktuelle Studienergebnisse zur Akuttherapie des ischämischen Schlaganfalls zusammen und gibt Empfehlungen für eine evidenzbasierte Bildgebung als Grundlage effektiver Reperfusionstherapien.

ABSTRACT

Ongoing development of established as well as the discovery of new therapeutic targets in recent years have led to improvements in hyperacute ischemic stroke care. Based on advanced acute stroke imaging with either CT or MRI it is now possible to offer thrombolysis or thrombectomy to some patients who had previously been excluded from these recanalizing treatments. In addition, promising results have been obtained for neuroprotective and immunomodulatory approaches. Finally, due to the interdisciplinary nature of acute stroke care, intra-hospital process improvement has received considerable attention. In the present article, we summarise recent evidence relevant to the treatment of hyperacute ischemic stroke and derive recommendations for the evidence-based selection of advanced imaging modalities to guide decisions about effective reperfusion therapies.

Schlüsselwörter

Ischämischer Schlaganfall - Akuttherapie - Thrombolyse - Thrombektomie - Neuroprotektion - Prozessoptimierung

Key words

Ischemic stroke - reperfusion treatment - thrombolysis - thrombectomy - stroke imaging - neuroprotection - process management

^* gleichberechtigte Autorenschaft

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