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2016 | Apoplex | OriginalPaper | Buchkapitel

1. Ischämischer Schlaganfall (zerebrale Ischämie)

verfasst von : A. Reich, O. Nikoubashman

Erschienen in: Neurologische Notfälle

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Im Folgenden werden praxisrelevante Inhalte als Grundlagen für eine erfolgreiche prä- und intrahospitale Schlaganfallrettungskette dargestellt. Ziel einer zeitoptimierten Patientenversorgung beim ischämischen Schlaganfall ist die Beantwortung der Frage, ob für den individuellen Fall die Anwendung von zerebralen Reperfusionsmaßnahmen möglich ist. Die Indikationsstellung und Durchführung dieser Maßnahmen obliegt vaskulären Neurologen und interventionellen Neuroradiologen und sollte in Kliniken mit zertifizierten Schlaganfalleinheiten durchgeführt werden. Für die fachspezifischen Inhalte wird auf die Leitlinien der jeweiligen deutschen Fachgesellschaften und der deutschen Schlaganfall-Gesellschaft verwiesen (www.dgn.org, www.dgnr.org, www.dsg-info.de).
Literatur
Zurück zum Zitat Adams, H. P. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24, 35–41 (1993)CrossRefPubMed Adams, H. P. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24, 35–41 (1993)CrossRefPubMed
Zurück zum Zitat Albers, G. W. et al. Transient ischemic attack––proposal for a new definition. N. Engl. J. Med. 347, 1713–1716 (2002)CrossRefPubMed Albers, G. W. et al. Transient ischemic attack––proposal for a new definition. N. Engl. J. Med. 347, 1713–1716 (2002)CrossRefPubMed
Zurück zum Zitat Aries, M. J. H., Elting, J. W., De Keyser, J., Kremer, B. P. H. & Vroomen, P. C. A. J. Cerebral Autoregulation in Stroke A Review of Transcranial Doppler Studies. Stroke 41, 2697–2704 (2010)CrossRefPubMed Aries, M. J. H., Elting, J. W., De Keyser, J., Kremer, B. P. H. & Vroomen, P. C. A. J. Cerebral Autoregulation in Stroke A Review of Transcranial Doppler Studies. Stroke 41, 2697–2704 (2010)CrossRefPubMed
Zurück zum Zitat Atkins, E. R., Brodie, F. G., Rafelt, S. E., Panerai, R. B. & Robinson, T. G. Dynamic Cerebral Autoregulation Is Compromised Acutely following Mild Ischaemic Stroke but Not Transient Ischaemic Attack. Cerebrovasc Dis 29, 228–235 (2010)CrossRefPubMed Atkins, E. R., Brodie, F. G., Rafelt, S. E., Panerai, R. B. & Robinson, T. G. Dynamic Cerebral Autoregulation Is Compromised Acutely following Mild Ischaemic Stroke but Not Transient Ischaemic Attack. Cerebrovasc Dis 29, 228–235 (2010)CrossRefPubMed
Zurück zum Zitat Barber, P. A., Demchuk, A. M., Zhang, J. & Buchan, A. M. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. The Lancet 355, 1670–1674 (2000)CrossRef Barber, P. A., Demchuk, A. M., Zhang, J. & Buchan, A. M. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. The Lancet 355, 1670–1674 (2000)CrossRef
Zurück zum Zitat Baron, J. C. Mapping the ischaemic penumbra with PET: implications for acute stroke treatment. Cerebrovasc Dis 9, 193–201 (1999)CrossRefPubMed Baron, J. C. Mapping the ischaemic penumbra with PET: implications for acute stroke treatment. Cerebrovasc Dis 9, 193–201 (1999)CrossRefPubMed
Zurück zum Zitat Berkhemer, O. A. et al. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. N. Engl. J. Med. 141217070022009 (2014). doi:10.1056/NEJMoa1411587 Berkhemer, O. A. et al. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. N. Engl. J. Med. 141217070022009 (2014). doi:10.1056/NEJMoa1411587
Zurück zum Zitat Bouvin, V. Consensus statementon mechanical thrombectomy in acute ischemic stroke. 1–14 (2015) Bouvin, V. Consensus statementon mechanical thrombectomy in acute ischemic stroke. 1–14 (2015)
Zurück zum Zitat Broderick, J. et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38, 2001–2023 (2007)CrossRefPubMed Broderick, J. et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38, 2001–2023 (2007)CrossRefPubMed
Zurück zum Zitat Campbell, B. C. V. et al. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N. Engl. J. Med. 150211090353006 (2015). doi:10.1056/NEJMoa1414792 Campbell, B. C. V. et al. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N. Engl. J. Med. 150211090353006 (2015). doi:10.1056/NEJMoa1414792
Zurück zum Zitat Easton, J. D. et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 40, 2276–2293 (2009)CrossRefPubMed Easton, J. D. et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 40, 2276–2293 (2009)CrossRefPubMed
Zurück zum Zitat Edlow JA, Selim MH. Atypical presentations of acute cerebrovascular syndromes. The Lancet Neurology 10, 550–560 (2011)CrossRefPubMed Edlow JA, Selim MH. Atypical presentations of acute cerebrovascular syndromes. The Lancet Neurology 10, 550–560 (2011)CrossRefPubMed
Zurück zum Zitat Feigin VL et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. The Lancet 383, 245–255 (2014)CrossRef Feigin VL et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. The Lancet 383, 245–255 (2014)CrossRef
Zurück zum Zitat Goyal, M. et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N. Engl. J. Med. 150211090353006 (2015). doi:10.1056/NEJMoa1414905 Goyal, M. et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N. Engl. J. Med. 150211090353006 (2015). doi:10.1056/NEJMoa1414905
Zurück zum Zitat Hacke, W. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N. Engl. J. Med. 359, 1317–1329 (2008)CrossRefPubMed Hacke, W. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N. Engl. J. Med. 359, 1317–1329 (2008)CrossRefPubMed
Zurück zum Zitat Heldner, M. R. et al. National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic Stroke. Stroke 44, 1153–1157 (2013)CrossRefPubMed Heldner, M. R. et al. National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic Stroke. Stroke 44, 1153–1157 (2013)CrossRefPubMed
Zurück zum Zitat Heuschmann, P. et al. Schlaganfallhäufigkeit und Versorgung von Schlaganfallpatienten in Deutschland. Akt Neurol 37, 333–340 (2010)CrossRef Heuschmann, P. et al. Schlaganfallhäufigkeit und Versorgung von Schlaganfallpatienten in Deutschland. Akt Neurol 37, 333–340 (2010)CrossRef
Zurück zum Zitat Hurford, R. et al. Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke. Journal of Neurology, Neurosurgery & Psychiatry 86, 520–523 (2015)CrossRef Hurford, R. et al. Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke. Journal of Neurology, Neurosurgery & Psychiatry 86, 520–523 (2015)CrossRef
Zurück zum Zitat Johnston, S. C. et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. The Lancet 369, 283–292 (2007)CrossRef Johnston, S. C. et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. The Lancet 369, 283–292 (2007)CrossRef
Zurück zum Zitat Jovin, T. G. et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. N. Engl. J. Med. 150417035025009 (2015). doi:10.1056/NEJMoa1503780 Jovin, T. G. et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. N. Engl. J. Med. 150417035025009 (2015). doi:10.1056/NEJMoa1503780
Zurück zum Zitat Kasner, S. E. Clinical interpretation and use of stroke scales. The Lancet Neurology 5, 603–612 (2006)CrossRefPubMed Kasner, S. E. Clinical interpretation and use of stroke scales. The Lancet Neurology 5, 603–612 (2006)CrossRefPubMed
Zurück zum Zitat Lees, K. R. et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. The Lancet 375, 1695–1703 (2010)CrossRef Lees, K. R. et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. The Lancet 375, 1695–1703 (2010)CrossRef
Zurück zum Zitat Li, L. et al. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. The Lancet Neurology 14, 903–913 (2015)CrossRefPubMed Li, L. et al. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. The Lancet Neurology 14, 903–913 (2015)CrossRefPubMed
Zurück zum Zitat Lip, G. Y. H., Frison, L., Halperin, J. L. & Lane, D. A. Identifying Patients at High Risk for Stroke Despite Anticoagulation A Comparison of Contemporary Stroke Risk Stratification Schemes in an Anticoagulated Atrial Fibrillation Cohort. Stroke 41, 2731–2738 (2010b)CrossRefPubMed Lip, G. Y. H., Frison, L., Halperin, J. L. & Lane, D. A. Identifying Patients at High Risk for Stroke Despite Anticoagulation A Comparison of Contemporary Stroke Risk Stratification Schemes in an Anticoagulated Atrial Fibrillation Cohort. Stroke 41, 2731–2738 (2010b)CrossRefPubMed
Zurück zum Zitat Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A. & Crijns, H. J. G. M. Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach The Euro Heart Survey on Atrial Fibrillation. Chest 137, 263–272 (2010a)CrossRefPubMed Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A. & Crijns, H. J. G. M. Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach The Euro Heart Survey on Atrial Fibrillation. Chest 137, 263–272 (2010a)CrossRefPubMed
Zurück zum Zitat Lozano, R., Naghavi, M., Foreman, K., Lim, S. & Shibuya, K. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet (2013) Lozano, R., Naghavi, M., Foreman, K., Lim, S. & Shibuya, K. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet (2013)
Zurück zum Zitat Meretoja, A. et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology 81, 1071–1076 (2013)CrossRefPubMed Meretoja, A. et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology 81, 1071–1076 (2013)CrossRefPubMed
Zurück zum Zitat Meretoja, A. et al. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 79, 306–313 (2012)CrossRefPubMed Meretoja, A. et al. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 79, 306–313 (2012)CrossRefPubMed
Zurück zum Zitat Murray, C., Vos, T., Lozano, R., Naghavi, M. & Flaxman, A. D. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet (2013) Murray, C., Vos, T., Lozano, R., Naghavi, M. & Flaxman, A. D. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet (2013)
Zurück zum Zitat Nabavi, D. G. et al. [Revised certification criteria for regional and national stroke units in Germany]. Nervenarzt 86, 978–988 (2015)CrossRefPubMed Nabavi, D. G. et al. [Revised certification criteria for regional and national stroke units in Germany]. Nervenarzt 86, 978–988 (2015)CrossRefPubMed
Zurück zum Zitat Nguyen, P. L. & Chang, J. J. Stroke Mimics and Acute Stroke Evaluation: Clinical Differentiation and Complications after Intravenous Tissue Plasminogen Activator. J Emerg Med 49, 244–252 (2015)CrossRefPubMed Nguyen, P. L. & Chang, J. J. Stroke Mimics and Acute Stroke Evaluation: Clinical Differentiation and Complications after Intravenous Tissue Plasminogen Activator. J Emerg Med 49, 244–252 (2015)CrossRefPubMed
Zurück zum Zitat Rha, J. H. & Saver, J. L. The Impact of Recanalization on Ischemic Stroke Outcome: A Meta-Analysis. Stroke 38, 967–973 (2007)CrossRefPubMed Rha, J. H. & Saver, J. L. The Impact of Recanalization on Ischemic Stroke Outcome: A Meta-Analysis. Stroke 38, 967–973 (2007)CrossRefPubMed
Zurück zum Zitat Saver, J. L. & Levine, S. R. Alteplase for ischaemic stroke—much sooner is much better. The Lancet 375, 1667–1668 (2010)CrossRef Saver, J. L. & Levine, S. R. Alteplase for ischaemic stroke—much sooner is much better. The Lancet 375, 1667–1668 (2010)CrossRef
Zurück zum Zitat Saver, J. L. et al. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. N. Engl. J. Med. 150417023017004 (2015). doi:10.1056/NEJMoa1415061 Saver, J. L. et al. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. N. Engl. J. Med. 150417023017004 (2015). doi:10.1056/NEJMoa1415061
Zurück zum Zitat Saver, J. L. et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA 309, 2480–2488 (2013)CrossRefPubMed Saver, J. L. et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA 309, 2480–2488 (2013)CrossRefPubMed
Zurück zum Zitat Schneider, K., Heise, M., Heuschmann, P. & Berger, K. Situation of life and care in patients with a stroke. Nervenheilkunde 28, 114–+ (2009) Schneider, K., Heise, M., Heuschmann, P. & Berger, K. Situation of life and care in patients with a stroke. Nervenheilkunde 28, 114–+ (2009)
Zurück zum Zitat Schwamm, L. H. Acute Stroke: Shifting From Informed Consent to Informed Refusal of Intravenous Tissue-Type Plasminogen Activator. Circ Cardiovasc Qual Outcomes 8, S69–72 (2015)CrossRef Schwamm, L. H. Acute Stroke: Shifting From Informed Consent to Informed Refusal of Intravenous Tissue-Type Plasminogen Activator. Circ Cardiovasc Qual Outcomes 8, S69–72 (2015)CrossRef
Zurück zum Zitat Spiotta, A. M. et al. Evolution of thrombectomy approaches and devices for acute stroke: a technical review. Journal of NeuroInterventional Surgery (2014). doi:10.1136/neurintsurg-2013-011022 Spiotta, A. M. et al. Evolution of thrombectomy approaches and devices for acute stroke: a technical review. Journal of NeuroInterventional Surgery (2014). doi:10.1136/neurintsurg-2013-011022
Zurück zum Zitat The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N. Engl. J. Med. 333, 1581–1587 (1995)CrossRef The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N. Engl. J. Med. 333, 1581–1587 (1995)CrossRef
Zurück zum Zitat Tong, D. Are all IV thrombolysis exclusion criteria necessary?: Being SMART about evidence-based medicine. Neurology 76, 1780–1781 (2011)CrossRefPubMed Tong, D. Are all IV thrombolysis exclusion criteria necessary?: Being SMART about evidence-based medicine. Neurology 76, 1780–1781 (2011)CrossRefPubMed
Zurück zum Zitat Tong, D. C. Avoiding Thrombolysis In Patients With Mild Stroke: Is It SMART? Stroke 43, 625–626 (2012)CrossRefPubMed Tong, D. C. Avoiding Thrombolysis In Patients With Mild Stroke: Is It SMART? Stroke 43, 625–626 (2012)CrossRefPubMed
Zurück zum Zitat Tsivgoulis, G. et al. Safety of Intravenous Thrombolysis in Stroke Mimics. (2015) Tsivgoulis, G. et al. Safety of Intravenous Thrombolysis in Stroke Mimics. (2015)
Zurück zum Zitat Unal, B., Critchley, J. A. & Capewell, S. Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000. Circulation (2004) Unal, B., Critchley, J. A. & Capewell, S. Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000. Circulation (2004)
Zurück zum Zitat Walter, S. et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. The Lancet Neurology 11, 397–404 (2012)CrossRefPubMed Walter, S. et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. The Lancet Neurology 11, 397–404 (2012)CrossRefPubMed
Zurück zum Zitat Ward, A., Payne, K. A., Caro, J. J., Heuschmann, P. U. & Kolominsky-Rabas, P. L. Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project. Eur J Neurol 12, 264–267 (2005)CrossRefPubMed Ward, A., Payne, K. A., Caro, J. J., Heuschmann, P. U. & Kolominsky-Rabas, P. L. Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project. Eur J Neurol 12, 264–267 (2005)CrossRefPubMed
Zurück zum Zitat Wardlaw, J. M., Murray, V., Berge, E. & del Zoppo, G. J. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 7, CD000213 (2014)PubMedPubMedCentral Wardlaw, J. M., Murray, V., Berge, E. & del Zoppo, G. J. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 7, CD000213 (2014)PubMedPubMedCentral
Zurück zum Zitat Zaidat, O. O. et al. Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke: A Consensus Statement. Stroke 44, 2650–2663 (2013)CrossRefPubMedPubMedCentral Zaidat, O. O. et al. Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke: A Consensus Statement. Stroke 44, 2650–2663 (2013)CrossRefPubMedPubMedCentral
Metadaten
Titel
Ischämischer Schlaganfall (zerebrale Ischämie)
verfasst von
A. Reich
O. Nikoubashman
Copyright-Jahr
2016
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-49775-3_1

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