Schlaganfall akut – ein Update

Zusammenfassung

Die optimale Akutversorgung des Schlaganfallpatienten erfordert gut strukturierte Abläufe in der Prähospitalphase und beim Eintreffen des Patienten in der Klinik. In der Prähospitalphase kommt der gezielten Zuweisung des Schlaganfallpatienten eine wesentliche Rolle zu. Studien zeigen, dass es zu einer Vervielfachung der Thrombolyserate bei direkter Zuweisung in Schlaganfallzentren kommt. Im Schlaganfallzentrum ist ein multidisziplinäres Vorgehen zum Erreichen kurzer Door-to-Needle-Zeiten mit dem Ziel < 30 min erforderlich. Hierzu ist ein permanentes Training aller Berufsgruppen und fortwährend wiederholte Bevölkerungsaufklärung notwendig. Neue Studien zeigen, dass auch alte Patienten von der Behandlung auf der Stroke Unit profitieren. Während der Thrombolyse ist die Blutdrucküberwachung von wesentlicher Bedeutung zur Vermeidung einer symptomatischen intrazerebralen Blutung. Systolische Blutdruckwerte zwischen 140 –150 mmHg korrelieren mit einer geringen Komplikationsrate. Die Analyse weiterer Subgruppen der ECASS-III-Studie ergab, dass die Thrombolysetherapie im 3- bis 4-Stundenzeitfenster für eine große Bandbreite von Patienten sicher und effektiv ist. Neue endovaskuläre Rekanalisationstherapien erzielen eine hohe Rekanalisationsrate. Ob diese auch mit einem signifikant besseren Behandlungsergebnis einhergeht, müssen weitere Studien zeigen.

Abstract

An optimised prehospital management is important for acute stroke patients. A structured admittance to a stroke centre increases the rate of thrombolysis four-fold. To achieve short door-to-needle-times (< 30 min) a multi-disciplinary approach is necessary. Elderly stroke patients benefit from stroke unit therapy as do the younger patients. Blood pressure management is important during the first 24 hours after thrombolysis. Systolic blood pressures between 140 – 150 mmHg correlate with low bleeding rates. A subgroup analysis of the ECASS III study shows that a broad range of patients can be treated safely and efficiently in the 3 – 4.5 hour time window. Endovascular recanalisation therapy achieves high recanalisation rates. Whether these will be responsible for a significantly better outcome has to be shown in future randomised trials.

Schlüsselwörter

Schlaganfall - Thrombolyse - Akuttherapie - intraarterielle Thrombolyse - Prähospitalmanagement

Keywords

stroke - thrombolysis - acute therapy - intraarterial thrombolysis - prehospital care

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