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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Prof. Dr. Joachim Röther
Neurologische Klinik, Asklepios Klinik Altona
Paul-Ehrlich-Str. 1
22763 Hamburg
Email: j.roether@asklepios.com
