Skip to main content
Erschienen in: DNP – Die Neurologie & Psychiatrie 6/2019

01.12.2019 | Apoplex | Zertifizierte Fortbildung

Moderne Schlaganfallversorgung

Diagnostik und Akuttherapie des ischämischen Schlaganfalls

verfasst von: PD Dr. med. Peter Kraft, Dr. med. Sami Nasri, Dr. med. Mirjam Dreikorn, Prof. Dr. med. Martin Köhrmann, Prof. Dr. med. Christoph Kleinschnitz

Erschienen in: DNP – Die Neurologie & Psychiatrie | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

Ischämische Schlaganfälle (IS) machen 85 – 90 % aller Schlaganfälle aus. IS und hämorrhagische Schlaganfälle können anhand der klinischen Untersuchung nicht differenziert werden. Der zunehmende Einsatz der mechanischen Thrombektomie wirft die Frage einer prähospitalen Triagierung von Patienten mit IS auf. Das Stroke-Unit-Konzept sowie die multimodale Bildgebung sind heute wesentliche Bestandteile der modernen Schlaganfallversorgung. Weiterhin bleibt die systemische Thrombolyse eine hocheffektive Behandlungsoption beim akuten IS, ist allerdings bei Kontraindikationen nicht immer einsetzbar.
Literatur
1.
Zurück zum Zitat Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke 2003;34:71–6CrossRef Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke 2003;34:71–6CrossRef
2.
Zurück zum Zitat Singer OC, Dvorak F, du Mesnil de Rochemont R, Lanfermann H, Sitzer M, Neumann-Haefelin T. A simple 3-item stroke scale: comparison with the National Institutes of Health Stroke Scale and prediction of middle cerebral artery occlusion. Stroke 2005;36:773–6CrossRef Singer OC, Dvorak F, du Mesnil de Rochemont R, Lanfermann H, Sitzer M, Neumann-Haefelin T. A simple 3-item stroke scale: comparison with the National Institutes of Health Stroke Scale and prediction of middle cerebral artery occlusion. Stroke 2005;36:773–6CrossRef
3.
Zurück zum Zitat Pérez de la Ossa N, Carrera D, Gorchs M, Querol M, Millán M, Gomis M et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke 2014;45:87–91CrossRef Pérez de la Ossa N, Carrera D, Gorchs M, Querol M, Millán M, Gomis M et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke 2014;45:87–91CrossRef
4.
Zurück zum Zitat Ebinger M, Winter B, Wendt M, Weber JE, Waldschmidt C, Rozanski M, et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 2014;311:1622–31CrossRef Ebinger M, Winter B, Wendt M, Weber JE, Waldschmidt C, Rozanski M, et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 2014;311:1622–31CrossRef
5.
Zurück zum Zitat Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL. Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Telemedic Pilot Project for Integrative Stroke Care Group. Lancet Neurol 2006;5:742–8CrossRef Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL. Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Telemedic Pilot Project for Integrative Stroke Care Group. Lancet Neurol 2006;5:742–8CrossRef
6.
Zurück zum Zitat Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317–29CrossRef Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317–29CrossRef
7.
Zurück zum Zitat Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20CrossRef Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20CrossRef
8.
Zurück zum Zitat National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–7CrossRef National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–7CrossRef
9.
Zurück zum Zitat Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317–29CrossRef Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317–29CrossRef
10.
Zurück zum Zitat Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010;375:1695–1703CrossRef Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010;375:1695–1703CrossRef
11.
Zurück zum Zitat Xian Y, Liang L, Smith EE, Schwamm LH, Reeves MJ, Olson DM et al. Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator. JAMA 2012;307:2600–8CrossRef Xian Y, Liang L, Smith EE, Schwamm LH, Reeves MJ, Olson DM et al. Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator. JAMA 2012;307:2600–8CrossRef
12.
Zurück zum Zitat Kermer P, Eschenfelder CC, Diener HC, Grond M, Abdalla Y, Althaus K et al. Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany — A national case collection. Int J Stroke 2017;12:383–91CrossRef Kermer P, Eschenfelder CC, Diener HC, Grond M, Abdalla Y, Althaus K et al. Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany — A national case collection. Int J Stroke 2017;12:383–91CrossRef
13.
Zurück zum Zitat Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11–21.CrossRef Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11–21.CrossRef
14.
Zurück zum Zitat Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018;378:708–18CrossRef Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018;378:708–18CrossRef
15.
Zurück zum Zitat Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B et al. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med 2018;379:611–22CrossRef Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B et al. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med 2018;379:611–22CrossRef
16.
Zurück zum Zitat Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med 2019;380:1795–803CrossRef Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med 2019;380:1795–803CrossRef
17.
Zurück zum Zitat Campbell BCV, Ma H, Ringleb PA, Parsons MW, Churilov L, Bendszus M et al. Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet 2019;394:139–47CrossRef Campbell BCV, Ma H, Ringleb PA, Parsons MW, Churilov L, Bendszus M et al. Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet 2019;394:139–47CrossRef
18.
Zurück zum Zitat Logallo N, Novotny V, Assmus J, Kvistad CE, Alteheld L, Rønning OM et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (nor-test): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol 2017;16:781–788.CrossRef Logallo N, Novotny V, Assmus J, Kvistad CE, Alteheld L, Rønning OM et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (nor-test): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol 2017;16:781–788.CrossRef
19.
Zurück zum Zitat Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med 2018;378:1573–82CrossRef Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med 2018;378:1573–82CrossRef
20.
Zurück zum Zitat Bivard A, Huang X, Levi CR, Spratt N, Campbell BCV, Cheripelli BK et al. Tenecteplase in ischemic stroke offers improved recanalization. Neurology 2017;89:62–7CrossRef Bivard A, Huang X, Levi CR, Spratt N, Campbell BCV, Cheripelli BK et al. Tenecteplase in ischemic stroke offers improved recanalization. Neurology 2017;89:62–7CrossRef
Metadaten
Titel
Moderne Schlaganfallversorgung
Diagnostik und Akuttherapie des ischämischen Schlaganfalls
verfasst von
PD Dr. med. Peter Kraft
Dr. med. Sami Nasri
Dr. med. Mirjam Dreikorn
Prof. Dr. med. Martin Köhrmann
Prof. Dr. med. Christoph Kleinschnitz
Publikationsdatum
01.12.2019
Verlag
Springer Medizin
Erschienen in
DNP – Die Neurologie & Psychiatrie / Ausgabe 6/2019
Print ISSN: 2731-8168
Elektronische ISSN: 2731-8176
DOI
https://doi.org/10.1007/s15202-019-2118-7

Weitere Artikel der Ausgabe 6/2019

DNP – Die Neurologie & Psychiatrie 6/2019 Zur Ausgabe