Mechanische Rekanalisationstherapien beim akuten Schlaganfall

Zusammenfassung

Neben der seit 2002 zur Behandlung des akuten ischämischen Schlaganfalles in Deutschland zugelassenen systemischen Thrombolyse mit rekombinantem Gewebeplasminogenaktivator (rtPA) werden vermehrt endovaskuläre Rekanalisationstherapien sowohl in wissenschaftlichen Studien als auch in der klinischen Routine eingesetzt. Hierbei werden in erster Linie klinisch schwer betroffene Patienten mit einem akuten Verschluss eines großen hirnversorgenden Gefäßes (Hauptstamm der A. cerebri media, intrakranielle A. carotis interna, A. basilaris) behandelt. Obwohl die angiografischen Daten, insbesondere die Rekanalisationsraten überzeugend sind und in Einzelfällen dramatische klinische Verbesserungen zu erzielen sind, ist der klinische Nutzen der endovaskulären Schlaganfalltherapie noch nicht abschließend geklärt. Dieser Übersichtsartikel informiert über gängige Indikationen, Verfahren und prozedurale Aspekte der mechanischen Rekanalisationstherapie.

Summary

Mechanical recanalization strategies are increasingly used for acute stroke treatment due to proximal vessel occlusion, e. g. of the proximal middle cerebral artery, the intracranial part of the internal carotid artery, the basilar artery. This elaborate treatment is primarily used in severely affected patients. Although angiography data concerning recanalization rates are compelling and clinical success can be substantial in selected patients, the clinical impact as well as its risk / benefit ratio is not definitely evaluated by now. This review informs about common indications, different types and procedural aspects of mechanical recanalization therapies.

Schlüsselwörter

Akuter Schlaganfall - endovaskuläre Therapie - mechanische Rekanalisation

Keywords

Acute stroke - endovascular treatment - mechanical recanalization

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