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2015 | OriginalPaper | Buchkapitel

28. Basilaristhrombose – Ischämie des hinteren Kreislaufs – Hirnstammsyndrome

verfasst von : Peter Schellinger, Prof. Dr., Gernot Schulte-Altedorneburg, PD Dr., Werner Hacke, Prof. Dr. Dr.

Erschienen in: NeuroIntensiv

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Ischämien des hinteren Kreislaufs schließen Infarkte im Versorgungsgebiet der Aa. vertebrales, der A. basilaris und der Aa. posteriores ein. Die klinische Befundkonstellation ist äußerst variabel, was an dem Variantenreichtum der Blutversorgung (variables Oberflächensystem vs. pontines Binnensystem, variable Kollateralisierung), aber auch an der hohen Dichte von Kerngebieten und Faserbahnen liegt. Während Infarkte der A. vertebralis (VA) und der A. cerebri posterior (PCA) häufig mit leichten oder allenfalls mittelschweren neurologischen Ausfällen einhergehen, ist der akute Basilarisverschluss (thrombotisch oder embolisch) sowie das Basilarisspitzensyndrom eine lebensbedrohliche Erkrankung, bei der die Chance auf ein gutes klinisches Endergebnis ohne eine rechtzeitige Rekanalisation verschwindend gering ist. In diesem Kapitel werden die Symptomatik und die verschiedenen Therapieoptionen der vertebrobasilären Ischämien erörtert.
Literatur
1.
Zurück zum Zitat Adams HP Jr, Effron MB, Torner J et al (2008) Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II. Stroke 39:87–99CrossRefPubMed Adams HP Jr, Effron MB, Torner J et al (2008) Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II. Stroke 39:87–99CrossRefPubMed
2.
Zurück zum Zitat Becker KJ, Monsein LH, Ulatowski J, Mirski M, Williams M, Hanley DF (1996) Intraarterial thrombolysis in vertebrobasilar occlusion. AJNR Am J Neuroradiol 17:255–262PubMed Becker KJ, Monsein LH, Ulatowski J, Mirski M, Williams M, Hanley DF (1996) Intraarterial thrombolysis in vertebrobasilar occlusion. AJNR Am J Neuroradiol 17:255–262PubMed
3.
Zurück zum Zitat Brandt T, von Kummer R, Muller Kuppers M, Hacke W (1996) Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 27:875–881CrossRefPubMed Brandt T, von Kummer R, Muller Kuppers M, Hacke W (1996) Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 27:875–881CrossRefPubMed
4.
Zurück zum Zitat Brandt T, Knauth M, Wildermuth S, Winter R, von Kummer R, Sartor K, Hacke W (1999) CT angiography and Doppler sonography for emergency assessment in acute basilar artery ischemia. Stroke 30:606–612CrossRefPubMed Brandt T, Knauth M, Wildermuth S, Winter R, von Kummer R, Sartor K, Hacke W (1999) CT angiography and Doppler sonography for emergency assessment in acute basilar artery ischemia. Stroke 30:606–612CrossRefPubMed
5.
Zurück zum Zitat Broderick JP, Palesch YY, Demchuk AM et al (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368:893–903. doi:10.1056/NEJMoa1214300CrossRefPubMedPubMedCentral Broderick JP, Palesch YY, Demchuk AM et al (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368:893–903. doi:10.1056/NEJMoa1214300CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Chimowitz MI, Lynn MJ, Derdeyn CP et al (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003. doi:10.1056/NEJMoa1105335CrossRefPubMedPubMedCentral Chimowitz MI, Lynn MJ, Derdeyn CP et al (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003. doi:10.1056/NEJMoa1105335CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Cho TH, Nighoghossian N, Tahon F et al (2009) Brain Stem Diffusion-Weighted Imaging Lesion Score: A Potential Marker of Outcome in Acute Basilar Artery Occlusion. Am J Neuroradiol 30:194–198CrossRefPubMed Cho TH, Nighoghossian N, Tahon F et al (2009) Brain Stem Diffusion-Weighted Imaging Lesion Score: A Potential Marker of Outcome in Acute Basilar Artery Occlusion. Am J Neuroradiol 30:194–198CrossRefPubMed
8.
Zurück zum Zitat Eckert B, Koch C, Thomalla G, Kucinski T, Grzyska U, Roether J, Alfke K, Jansen O, Zeumer H (2005) Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke 36:1160–1165CrossRefPubMed Eckert B, Koch C, Thomalla G, Kucinski T, Grzyska U, Roether J, Alfke K, Jansen O, Zeumer H (2005) Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. Stroke 36:1160–1165CrossRefPubMed
9.
Zurück zum Zitat Flossmann E, Rothwell PM (2003) Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain 126:1940–1954CrossRefPubMed Flossmann E, Rothwell PM (2003) Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain 126:1940–1954CrossRefPubMed
10.
Zurück zum Zitat Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. Jama 282:2003–2011CrossRefPubMed Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. Jama 282:2003–2011CrossRefPubMed
11.
Zurück zum Zitat Hacke W, Zeumer H, Ferbert A, Brückmann H, DelZoppo G (1988) Intraarterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:1216–1222CrossRefPubMed Hacke W, Zeumer H, Ferbert A, Brückmann H, DelZoppo G (1988) Intraarterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:1216–1222CrossRefPubMed
12.
Zurück zum Zitat Jauss M, Krieger D, Hornig C, Schramm J, Busse O (1999) Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study. J Neurol 246:257–264CrossRefPubMed Jauss M, Krieger D, Hornig C, Schramm J, Busse O (1999) Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study. J Neurol 246:257–264CrossRefPubMed
13.
Zurück zum Zitat Krasnianski M, Winterholler M, Neudecker S et al (2003) Classical crossed syndromes of the medulla oblongata. A historical and topodiagnostic discussion. Fortschr Neurol Psychiatr 71:397–405. doi:10.1055/s-2003-41192CrossRefPubMed Krasnianski M, Winterholler M, Neudecker S et al (2003) Classical crossed syndromes of the medulla oblongata. A historical and topodiagnostic discussion. Fortschr Neurol Psychiatr 71:397–405. doi:10.1055/s-2003-41192CrossRefPubMed
14.
Zurück zum Zitat Krasnianski M, Neudecker S, Zierz S (2004) Classical crossed pontine syndromes. Fortschr Neurol Psychiatr 72:460–468. doi:10.1055/s-2004-818392CrossRefPubMed Krasnianski M, Neudecker S, Zierz S (2004) Classical crossed pontine syndromes. Fortschr Neurol Psychiatr 72:460–468. doi:10.1055/s-2004-818392CrossRefPubMed
15.
Zurück zum Zitat Lindsberg PJ, Mattle HP (2006) Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 37:922–928CrossRefPubMed Lindsberg PJ, Mattle HP (2006) Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 37:922–928CrossRefPubMed
16.
Zurück zum Zitat Lindsberg PJ, Soinne L, Tatlisumak T, Roine RO, Kallela M, Happola O, Kaste M (2004) Long-term outcome after intravenous thrombolysis of basilar artery occlusion. Jama 292:1862–1866CrossRefPubMed Lindsberg PJ, Soinne L, Tatlisumak T, Roine RO, Kallela M, Happola O, Kaste M (2004) Long-term outcome after intravenous thrombolysis of basilar artery occlusion. Jama 292:1862–1866CrossRefPubMed
17.
Zurück zum Zitat Macleod MR, Davis SM, Mitchell PJ, Gerraty RP, Fitt G, Hankey GJ, Stewart-Wynne EG, Rosen D, McNeil JJ, Bladin CF, Chambers BR, Herkes GK, Young D, Donnan GA (2005) Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke. Cerebrovasc Dis 20:12–17CrossRefPubMed Macleod MR, Davis SM, Mitchell PJ, Gerraty RP, Fitt G, Hankey GJ, Stewart-Wynne EG, Rosen D, McNeil JJ, Bladin CF, Chambers BR, Herkes GK, Young D, Donnan GA (2005) Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke. Cerebrovasc Dis 20:12–17CrossRefPubMed
18.
Zurück zum Zitat Muller R, Pfefferkorn T, Vatankhah B, Mayer TE, Schenkel J, Dichgans M, Sander D, Audebert HJ (2007) Admission facility is associated with outcome of basilar artery occlusion. Stroke 38:1380–1383CrossRefPubMed Muller R, Pfefferkorn T, Vatankhah B, Mayer TE, Schenkel J, Dichgans M, Sander D, Audebert HJ (2007) Admission facility is associated with outcome of basilar artery occlusion. Stroke 38:1380–1383CrossRefPubMed
19.
Zurück zum Zitat Pagola J, Ribo M, Alvarez-Sabin J et al (2009) Thrombolysis in Anterior Versus Posterior Circulation Strokes: Timing of Recanalization, Ischemic Tolerance, and Other Differences. J Neuroimaging XX:1–5 Pagola J, Ribo M, Alvarez-Sabin J et al (2009) Thrombolysis in Anterior Versus Posterior Circulation Strokes: Timing of Recanalization, Ischemic Tolerance, and Other Differences. J Neuroimaging XX:1–5
20.
Zurück zum Zitat Pfefferkorn T, Mayer TE, Schulte-Altedorneburg G, Bruckmann H, Hamann GF, Dichgans M (2006) Diagnosis and therapy of basilar artery occlusion. Nervenarzt 77:416–422CrossRefPubMed Pfefferkorn T, Mayer TE, Schulte-Altedorneburg G, Bruckmann H, Hamann GF, Dichgans M (2006) Diagnosis and therapy of basilar artery occlusion. Nervenarzt 77:416–422CrossRefPubMed
21.
Zurück zum Zitat Pfefferkorn T, Holtmannspotter M, Schmidt C et al (2010) Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion. Stroke 41:722–726CrossRefPubMed Pfefferkorn T, Holtmannspotter M, Schmidt C et al (2010) Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion. Stroke 41:722–726CrossRefPubMed
22.
Zurück zum Zitat Schellinger PD (2005) The evolving role of advanced MR imaging as a management tool for adult ischemic stroke: a Western-European perspective. Neuroimaging Clin N Am 15:245–258 (ix)CrossRefPubMed Schellinger PD (2005) The evolving role of advanced MR imaging as a management tool for adult ischemic stroke: a Western-European perspective. Neuroimaging Clin N Am 15:245–258 (ix)CrossRefPubMed
23.
Zurück zum Zitat Schellinger PD, Hacke W (2006) Intra-arterial thrombolysis is the treatment of choice for basilar thrombosis: pro. Stroke 37:2436–2437CrossRefPubMed Schellinger PD, Hacke W (2006) Intra-arterial thrombolysis is the treatment of choice for basilar thrombosis: pro. Stroke 37:2436–2437CrossRefPubMed
24.
Zurück zum Zitat Schellinger PD, Schwab S, Krieger D, Fiebach JB, Steiner T, Hund EF, Hacke W, Meinck HM (2001) Masking of Vertebral Artery Dissection by Severe Trauma to the Cervical Spine. Spine 26:314–319CrossRefPubMed Schellinger PD, Schwab S, Krieger D, Fiebach JB, Steiner T, Hund EF, Hacke W, Meinck HM (2001) Masking of Vertebral Artery Dissection by Severe Trauma to the Cervical Spine. Spine 26:314–319CrossRefPubMed
25.
Zurück zum Zitat Schonewille WJ, Wijman CA, Michel P et al (2009) Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 8:724–730CrossRefPubMed Schonewille WJ, Wijman CA, Michel P et al (2009) Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 8:724–730CrossRefPubMed
26.
Zurück zum Zitat Schulte-Aledorneburg G, Bruckmann H (2006) Imaging techniques in diagnosis of brainstem infarction. Nervenarzt 77:731–743 (quiz 744)CrossRef Schulte-Aledorneburg G, Bruckmann H (2006) Imaging techniques in diagnosis of brainstem infarction. Nervenarzt 77:731–743 (quiz 744)CrossRef
27.
Zurück zum Zitat Schulte-Altedorneburg G, Mayer TE (2007) Management of acute basilar artery occlusion. Radiologe 47:355–358CrossRefPubMed Schulte-Altedorneburg G, Mayer TE (2007) Management of acute basilar artery occlusion. Radiologe 47:355–358CrossRefPubMed
28.
Zurück zum Zitat Schulte-Altedorneburg G, Droste DW, Popa V, Wohlgemuth WA, Kellermann M, Nabavi DG, Csiba L, Ringelstein EB (2000) Visualization of the basilar artery by transcranial color-coded duplex sonography: comparison with postmortem results. Stroke 31:1123–1127CrossRefPubMed Schulte-Altedorneburg G, Droste DW, Popa V, Wohlgemuth WA, Kellermann M, Nabavi DG, Csiba L, Ringelstein EB (2000) Visualization of the basilar artery by transcranial color-coded duplex sonography: comparison with postmortem results. Stroke 31:1123–1127CrossRefPubMed
29.
Zurück zum Zitat Schulte-Altedorneburg G, Hamann GF, Mull M, Kuhne D, Liebetrau M, Weber W, Bruckmann H, Mayer TE (2006) Outcome of acute vertebrobasilar occlusions treated with intra-arterial fibrinolysis in 180 patients. AJNR Am J Neuroradiol 27:2042–2047PubMed Schulte-Altedorneburg G, Hamann GF, Mull M, Kuhne D, Liebetrau M, Weber W, Bruckmann H, Mayer TE (2006) Outcome of acute vertebrobasilar occlusions treated with intra-arterial fibrinolysis in 180 patients. AJNR Am J Neuroradiol 27:2042–2047PubMed
30.
Zurück zum Zitat Schulte-Altedorneburg G, Reith W, Bruckmann H, Dichgans M, Mayer TE (2007) Thrombolysis of basilar artery occlusion-intra-arterial or intravenous: is there really no difference? Stroke 38:9 (author reply 10–11)CrossRefPubMed Schulte-Altedorneburg G, Reith W, Bruckmann H, Dichgans M, Mayer TE (2007) Thrombolysis of basilar artery occlusion-intra-arterial or intravenous: is there really no difference? Stroke 38:9 (author reply 10–11)CrossRefPubMed
31.
Zurück zum Zitat Strbian D, Sairanen T, Silvennoinen H et al (2014) Intravenous thrombolysis of basilar artery occlusion: thrombus length versus recanalization success. Stroke 45:1733–1738. doi:10.1161/STROKEAHA.114.004884CrossRefPubMed Strbian D, Sairanen T, Silvennoinen H et al (2014) Intravenous thrombolysis of basilar artery occlusion: thrombus length versus recanalization success. Stroke 45:1733–1738. doi:10.1161/STROKEAHA.114.004884CrossRefPubMed
32.
Zurück zum Zitat The IMS 2 Investigators: The Second Interventional Management of Stroke Study. In International Stroke Conference. Orlando, FL, USA, 2006 The IMS 2 Investigators: The Second Interventional Management of Stroke Study. In International Stroke Conference. Orlando, FL, USA, 2006
33.
Zurück zum Zitat The Penumbra Pivotal Stroke Trial Investigators (2009) The Penumbra Pivotal Stroke Trial. Stroke 40:2761–2768CrossRef The Penumbra Pivotal Stroke Trial Investigators (2009) The Penumbra Pivotal Stroke Trial. Stroke 40:2761–2768CrossRef
34.
Zurück zum Zitat van der Hoeven EJ, Schonewille WJ, Vos JA et al (2013) The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials 14:200 doi:10.1186/1745-6215-14-200CrossRefPubMedPubMedCentral van der Hoeven EJ, Schonewille WJ, Vos JA et al (2013) The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials 14:200 doi:10.1186/1745-6215-14-200CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Weber W, Mayer TE, Henkes H, Kis B, Hamann GF, Schulte-Altedorneburg G, Brueckmann H, Kuehne D (2005) Stent-angioplasty of intracranial vertebral and basilar artery stenoses in symptomatic patients. Eur J Radiol 55:231–236CrossRefPubMed Weber W, Mayer TE, Henkes H, Kis B, Hamann GF, Schulte-Altedorneburg G, Brueckmann H, Kuehne D (2005) Stent-angioplasty of intracranial vertebral and basilar artery stenoses in symptomatic patients. Eur J Radiol 55:231–236CrossRefPubMed
36.
Zurück zum Zitat Zeumer H, Hacke W, Kolmann HL, Poeck K (1982) Local fibrinolysis in basilar artery thrombosis (author‘s transl). Dtsch Med Wochenschr 107:728–731CrossRefPubMed Zeumer H, Hacke W, Kolmann HL, Poeck K (1982) Local fibrinolysis in basilar artery thrombosis (author‘s transl). Dtsch Med Wochenschr 107:728–731CrossRefPubMed
Metadaten
Titel
Basilaristhrombose – Ischämie des hinteren Kreislaufs – Hirnstammsyndrome
verfasst von
Peter Schellinger, Prof. Dr.
Gernot Schulte-Altedorneburg, PD Dr.
Werner Hacke, Prof. Dr. Dr.
Copyright-Jahr
2015
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-46500-4_28

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