nach oben

DGNeurologie

Erschienen in:

17.01.2022 | Apoplex | Leitlinie

S2e-Leitlinie: Akuttherapie des ischämischen Schlaganfalls

Kurzfassung der Leitlinie der Deutschen Gesellschaft für Neurologie

verfasst von: Prof. Dr. Peter A. Ringleb, Prof. Dr. Martin Köhrmann, die Leitlinien-Gruppe

Erschienen in: DGNeurologie | Ausgabe 1/2022

Einloggen, um Zugang zu erhalten

Auszug

Diese Leitlinie stellt eine Komplettüberarbeitung der bisherigen S1-Leitlinie aus dem Jahr 2012 [1] und der im Jahr 2015 publizierten Ergänzung zu den Rekanalisationstherapien [2] auf S2e-Niveau dar. Alle dortigen Empfehlungen haben sich in den Jahren inhaltlich, textlich und formal umfassend geändert, weswegen sie in diesem Kapitel nicht aufgeführt sind. …

Einschluss-Kriterien der THALES-Studie (Auszug): Alter ≥40 Jahre, Hirninfarkt mit NIHSS ≤5 oder TIA mit ABCD²-Score ≥6 oder einer ≥50 %igen symptomatischen intra- oder extrakraniellen Stenose

Einschluss-Kriterien der POINT-Studie (Auszug): Alter ≥18 Jahre, Hirninfarkt mit NIHSS ≤3 oder TIA mit ABCD²-Score ≥4

6- bis 16-h-Zeitfenster: Alter ≤90 Jahre, NIHSS ≥6, Infarktvolumen <70 ml, Penumbravolumen >15 ml und Penumbra-Infarktkern-Verhältnis >1,8

6- bis 24-h-Zeitfenster: Alter ≥80 Jahre, Infarktvolumen ≤20 ml, NIHSS ≥10

Veltkamp R, Fiehler J, Grond M et al (2012) Akuttherapie des ischämischen Schlaganfalls. In: Kommission „Leitlinien“ der Deutschen Gesellschaft für Neurologie, ed. Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart

Veltkamp R, Ringleb P Akuttherapie des ischämischen Schlaganfalls – Ergänzung 2015 – Rekanalisierende Therapie. https://www.awmf.org/leitlinien/detail/ll/030-140.html;. Zugegriffen: 4. Dez. 2015

Easton JD, Saver JL, Albers GW et al (2009) 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(6):2276–2293PubMed

Albers GW, Caplan LR, Easton JD et al (2002) Transient ischemic attack—proposal for a new definition. N Engl J Med 347(21):1713–1716PubMed

OCEBM Levels of Evidence Working Group, Oxford Centre for Evidence-Based Medicine (2011) Levels of Evidence. https://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf;. Zugegriffen: 17. Febr. 2019

Boulanger JM, Butcher K, Gubitz G et al Canadian stroke best practice recommendations acute stroke management: prehospital, emergency department, and acute inpatient stroke care. www.strokebestpractices.ca/recommendations/acute-stroke-management. Zugegriffen: 20. Febr. 2019

NICE Acute stroke. http://pathways.nice.org.uk/pathways/stroke;. Zugegriffen: 17. Febr. 2019

Harbison J, Hossain O, Jenkinson D et al (2003) Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke 34(1):71–76PubMed

Nor AM, McAllister C, Louw SJ et al (2004) Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients. Stroke 35(6):1355–1359PubMed

10.

Kidwell CS, Starkman S, Eckstein M et al (2000) Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 31(1):71–76PubMed

11.

Kothari RU, Pancioli A, Liu T et al (1999) Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med 33((4):373–378PubMed

12.

Bray JE, Martin J, Cooper G et al (2005) An interventional study to improve paramedic diagnosis of stroke. Prehosp Emerg Care 9(3):297–302PubMed

13.

Bray JE, Martin J, Cooper G et al (2005) Paramedic identification of stroke: community validation of the melbourne ambulance stroke screen. Cerebrovasc Dis 20(1):28–33PubMed

14.

Nor AM, Davis J, Sen B et al (2005) The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol 4(11):727–734PubMed

15.

Kobayashi A, Czlonkowska A, Ford GA et al (2018) European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke. Eur J Neurol 25(3):425–433PubMed

16.

Roffe C, Nevatte T, Sim J et al (2017) Effect of routine low-dose oxygen supplementation on death and disability in adults with acute stroke: the stroke oxygen study randomized clinical trial. JAMA 318(12):1125–1135PubMedPubMedCentral

17.

Mader FM, Schwenke R Schlaganfall – S3-Leitlinie. https://www.awmf.org/leitlinien/detail/ll/053-011.html;. Zugegriffen: 6. Mai 2020

18.

Australian National Stroke Foundation Clinical guidelines for stroke management. informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management-2017. Zugegriffen: 12. Jan. 2020

19.

Fuentes B, Ntaios G, Putaala J et al (2018) European Stroke Organisation (ESO) guidelines on glycaemia management in acute stroke. Eur Stroke J 3(1):5–21PubMed

20.

Johnston KC, Bruno A, Pauls Q et al (2019) Intensive vs standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke: the SHINE randomized clinical trial. JAMA 322(4):326–335PubMedPubMedCentral

21.

Powers WJ, Rabinstein AA, Ackerson T et al (2019) Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 50(12):e344–e418PubMed

22.

den Hertog HM, van der Worp HB, van Gemert HM et al (2009) The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol 8(5):434–440

23.

Dennis M, Caso V, Kappelle LJ et al (2016) European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic stroke. Eur Stroke J 1(1):6–19PubMedPubMedCentral

24.

Burgos R, Breton I, Cereda E et al (2018) ESPEN guideline clinical nutrition in neurology. Clin Nutr 37(1):354–396PubMed

25.

Wirth R, Smoliner C, Jager M et al (2013) Guideline clinical nutrition in patients with stroke. Exp Transl Stroke Med 5(1):14PubMedPubMedCentral

26.

Vermeij JD, Westendorp WF, Dippel DW et al (2018) Antibiotic therapy for preventing infections in people with acute stroke. Cochrane Database Syst Rev 1:CD8530. https://doi.org/10.1002/14651858.CD008530.pub3CrossRefPubMed

27.

Holtkamp M, Beghi E, Benninger F et al (2017) European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy. Eur Stroke J 2(2):103–115PubMedPubMedCentral

28.

Mansutti I, Saiani L, Palese A (2019) Detecting delirium in patients with acute stroke: a systematic review of test accuracy. BMC Neurol 19(1):310–321PubMedPubMedCentral

29.

Carin-Levy G, Mead G, Nicol K et al (2011) Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review. J Neurol 259:1590–1599

30.

Shi Q, Presutti R, Selchen D et al (2012) Delirium in acute stroke: a systematic review and meta-analysis. Stroke 43(3):645–649PubMed

31.

Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V. (DGAI), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e. V. (DIVI). S3-Leitlinie Analgesie, Sedierung und Delirmanagement in der Intensivmedizin (Registernummer 001-012). https://www.awmf.org/leitlinien/detail/ll/001-012.html;. Zugegriffen: 7. Sept. 2020

32.

Rice KL, Bennett MJ, Berger L et al (2017) A pilot randomized controlled trial of the feasibility of a multicomponent delirium prevention intervention versus usual care in acute stroke. J Cardiovasc Nurs 32(1):E1–E10PubMed

33.

Boßelmann C, Zurloh J, Stefanou MI et al (2019) Delirium screening in aphasic patients with the intensive care delirium screening checklist (ICDSC): a prospective cohort study. Front Neurol 10:1198PubMedPubMedCentral

34.

von Hofen-Hohloch J, Awissus C, Fischer MM et al (2020) Delirium screening in neurocritical care and stroke unit patients: a pilot study on the influence of neurological deficits on CAM-ICU and ICDSC outcome. Neurocrit Care 33(3):708–717

35.

Fleischmann R, Warwas S, Andrasch T et al (2021) Course and recognition of poststroke delirium: a prospective noninferiority trial of delirium screening tools. Stroke 52(2):471–478PubMed

36.

Infante MT, Pardini M, Balestrino M et al (2017) Delirium in the acute phase after stroke: comparison between methods of detection. Neurol Sci 38(6):1101–1104PubMed

37.

Kutlubaev M, Bikbulatova L, Akhmadeeva L (2016) Early diagnosis of delirium in elderly patients with acute stroke. Adv Gerontol 6(1):60–66

38.

Lees R, Corbet S, Johnston C et al (2013) Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke 44(11):3078–3083PubMed

39.

Mitasova A, Kostalova M, Bednarik J et al (2012) Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 40(2):484–490PubMed

40.

Berlit P, Busse O, Diener HC et al (1997) Empfehlungen für die Einrichtung von Schlaganfall-Spezialstationen (Stroke Units) – Aktualisierung 1997. Nervenarzt 69:180–185

41.

Audebert HJ, Schenkel J, Heuschmann PU et al (2006) Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol 5(9):742–748PubMed

42.

Nabavi DG, Koennecke HC, Ossenbrink M et al (2019) Zertifizierungskriterien fur Stroke-Units in Deutschland: Update 2018. Nervenarzt 90(4):335–342PubMed

43.

Turc G, Bhogal P, Fischer U et al (2019) European Stroke Organisation (ESO)—European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE). Eur Stroke J 4(1):6–12PubMedPubMedCentral

44.

Purrucker JC, Hartig F, Richter H et al (2017) Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: the shortened NIH Stroke Scale for emergency medical services. BMJ Open 7(9):e16893PubMedPubMedCentral

45.

Singer OC, Dvorak F, du Mesnil de Rochemont R et al (2005) A simple 3‑item stroke scale: comparison with the National Institutes of Health Stroke Scale and prediction of middle cerebral artery occlusion. Stroke 36(4):773–776PubMed

46.

Nazliel B, Starkman S, Liebeskind DS et al (2008) A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions. Stroke 39(8):22647

47.

de la Ossa PN, Carrera D, Gorchs M et al (2014) Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke 45(1):87–91

48.

Katz BS, McMullan JT, Sucharew H et al (2015) Design and validation of a prehospital scale to predict stroke severity: Cincinnati Prehospital Stroke Severity Scale. Stroke 46(6):1508–1512PubMedPubMedCentral

49.

Lima FO, Silva GS, Furie KL et al (2016) Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes. Stroke 47(8):1997–2002PubMedPubMedCentral

50.

Hastrup S, Damgaard D, Johnsen SP et al (2016) Prehospital acute stroke severity scale to predict large artery occlusion: design and comparison with other scales. Stroke 47(7):1772–1776PubMed

51.

Powers WJ, Rabinstein AA, Ackerson T et al (2018) 2018 guidelines for the early management of patients with acute Ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49(3):e46–e110PubMed

52.

Ciccone A, Celani MG, Chiaramonte R et al (2013) Continuous versus intermittent physiological monitoring for acute stroke. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008444.pub2CrossRefPubMed

53.

Middleton S, McElduff P, Ward J et al (2011) Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Lancet 378(9804):1699–1706PubMed

54.

de Bruijn SF, Agema WR, Lammers GJ et al (2006) Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke 37(10):2531–2534PubMed

55.

Holmes M, Rathbone J, Littlewood C et al (2014) Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation. Health Technol Assess 18(16):1–176PubMedPubMedCentral

56.

Schnabel RB, Haeusler KG, Healey JS et al (2019) Searching for atrial fibrillation poststroke: a white paper of the AF-SCREEN international collaboration. Circulation 140(22):1834–1850PubMed

57.

Häusler KG, Gröschel K, Köhrmann M et al (2018) Expert opinion paper on atrial fibrillation detection after ischemic stroke. Clin Res Cardiol 107(10):871–880

58.

Torbey MT, Bösel J, Rhoney DH et al (2015) Evidence-based guidelines for the management of large hemispheric infarction : a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine. Neurocrit Care 22(1):146–164PubMed

59.

Hindricks G, Potpara T, Dagres N et al (2020) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. https://doi.org/10.1093/eurheartj/ehaa612CrossRefPubMed

60.

Boulanger JM, Lindsay MP, Gubitz G et al (2018) Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. Int J Stroke 13(9):949–984PubMed

61.

Sanna T, Diener HC, Passman RS et al (2014) Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 370(26):2478–2486PubMed

62.

Chappell FM, Wardlaw JM, Young GR et al (2009) Carotid artery stenosis: accuracy of noninvasive tests—individual patient data meta-analysis. Radiology 251(2):493–502PubMed

63.

Zou H, Zhang Y, Tong J et al (2015) Multidetector computed tomography for detecting left atrial/left atrial appendage thrombus: a meta-analysis. Intern Med J 45(10):1044–1053PubMed

64.

Vira T, Pechlivanoglou P, Connelly K et al (2019) Cardiac computed tomography and magnetic resonance imaging vs. transoesophageal echocardiography for diagnosing left atrial appendage thrombi. Europace 21(1):e1–e10PubMed

65.

Aimo A, Kollia E, Ntritsos G et al (2020) Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01741-7CrossRefPubMed

66.

Groeneveld NS, Guglielmi V, Leeflang MMG et al (2020) CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis. J Neurol 267(6):1793–1801PubMedPubMedCentral

67.

Bornstein NM, Saver JL, Diener HC et al (2019) An injectable implant to stimulate the sphenopalatine ganglion for treatment of acute ischaemic stroke up to 24 h from onset (ImpACT-24B): an international, randomised, double-blind, sham-controlled, pivotal trial. Lancet 394(10194):219–229PubMed

68.

Bornstein NM, Saver JL, Diener HC et al (2019) Sphenopalatine ganglion stimulation to augment cerebral blood flow. Stroke 50:2108–2117PubMed

69.

Johnston SC, Easton JD, Farrant M et al (2018) Clopidogrel and aspirin in acute Ischemic stroke and high-risk TIA. N Engl J Med 379(3):215–225PubMedPubMedCentral

70.

Johnston SC, Amarenco P, Denison H et al (2020) Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med 383(3):207–217PubMed

71.

Wang Y, Wang Y, Zhao X et al (2013) Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 369(1):11–19PubMed

72.

Pollock A, Baer G, Campbell P et al (2014) Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001920.pub3CrossRefPubMedPubMedCentral

73.

Royal College of Physicians (2017) National clinical guideline for stroke

74.

AVERT Trial Collaboration group (2015) Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 386(9988):46–55

75.

Langhorne P, Collier JM, Bate PJ et al (2018) Very early versus delayed mobilisation after stroke. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006187.pub3CrossRefPubMedPubMedCentral

76.

(DGNR) DGfNeV S3-Leitlinie Rehabilitative Therapie bei Armparese nach Schlaganfall der DGNR (AWMF-Register-Nr. 080-001). www.awmf.org/leitlinien/detail/ll/080-001.html. Zugegriffen: 30. Sept. 2020

77.

Wattchow KA, McDonnell MN, Hillier SL (2018) Rehabilitation interventions for upper limb function in the first four weeks following stroke: a systematic review and meta-analysis of the evidence. Arch Phys Med Rehabil 99(2):367–382PubMed

78.

Hacke W, Kaste M, Fieschi C et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute stroke. JAMA 274(13):1017–1025PubMed

79.

The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333(24):1581–1587

80.

Wardlaw JM, Murray V, Berge E et al (2014) Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000213.pub3CrossRefPubMedPubMedCentral

81.

Emberson J, Lees KR, Lyden P et al (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384(9958):1929–1935PubMedPubMedCentral

82.

IST‑3 collaborative group, Sandercock P, Wardlaw JM et al (2012) The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 379(9834):2352–2363

83.

Wardlaw JM, Murray V, Berge E et al (2012) Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 379(9834):2364–2372PubMedPubMedCentral

84.

Thomalla G, Boutitie F, Ma H et al (2020) Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data. Lancet 396(10262):1574–1584PubMedPubMedCentral

85.

Campbell BCV, Ma H, Ringleb PA et al (2019) 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 394(10193):139–147PubMed

86.

Tsivgoulis G, Katsanos AH, Malhotra K et al (2020) Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window. Neurology 94(12):e1241–e1248PubMed

87.

European Medicines Agency (2020) Metalyse, summary of product characteristics. https://www.ema.europa.eu/en/documents/product-information/metalyse-epar-product-information_en.pdf; (Erstellt: 12.2020). Zugegriffen: 10. Dez. 2020

88.

Campbell BCV, Mitchell PJ, Churilov L et al (2018) Tenecteplase versus alteplase before thrombectomy for Ischemic stroke. N Engl J Med 378(17):1573–1582PubMed

89.

Anderson CS, Robinson T, Lindley RI et al (2016) Low-dose versus standard-dose intravenous alteplase in acute Ischemic stroke. N Engl J Med 374(24):2313–2323PubMed

90.

Nacu A, Kvistad CE, Naess H et al (2017) NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study): randomized controlled contrast-enhanced sonothrombolysis in an unselected acute Ischemic stroke population. Stroke 48(2):335–341PubMedPubMedCentral

91.

Alexandrov AV, Kohrmann M, Soinne L et al (2019) Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial. Lancet Neurol 18(4):338–347PubMed

92.

Ahmed N, Wahlgren N, Grond M et al (2010) Implementation and outcome of thrombolysis with alteplase 3–4.5 h after an acute stroke: an updated analysis from SITS-ISTR. Lancet Neurol 9(9):866–874PubMed

93.

Khatri P, Kleindorfer DO, Devlin T et al (2018) Effect of alteplase vs aspirin on functional outcome for patients with acute Ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial. JAMA 320(2):156–166PubMedPubMedCentral

94.

Anderson CS, Huang Y, Lindley RI et al (2019) Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet 393(10174):877–888PubMed

95.

Berkhemer OA, Fransen PS, Beumer D et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372(1):11–20PubMed

96.

Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018. https://doi.org/10.1056/NEJMoa1414792CrossRefPubMed

97.

Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731PubMed

98.

Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al (2015) Stent-retriever thrombectomy after intravenous t-pa vs. T-pa alone in stroke. N Engl J Med 372:2285–2295. https://doi.org/10.1056/NEJMoa1415061CrossRefPubMed

99.

Jovin TG, Chamorro A, Cobo E, Miquel MA de, Molina CA, Rovira A, et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2296–2306. https://doi.org/10.1056/NEJMoa1503780CrossRefPubMed

100.

Bracard S, Ducrocq X, Mas JL et al (2016) Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol 15(11):1138–1147PubMed

101.

Mocco J, Zaidat OO, von Kummer R et al (2016) Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone. Stroke 47(9):2331–2338PubMed

102.

Muir KW, Ford GA, Messow CM et al (2017) Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial. J Neurol Neurosurg Psychiatry 88(1):38–44PubMed

103.

Khoury NN, Darsaut TE, Ghostine J et al (2017) Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: a randomized care trial. J Neuroradiol 44(3):198–202PubMed

104.

Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378(1):11–21PubMed

105.

Albers GW, Marks MP, Kemp S et al (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378(8):708–718PubMedPubMedCentral

106.

Barber PA, Demchuk AM, Zhang J et al (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 355(9216):16704

107.

Campbell BC, Hill MD, Rubiera M et al (2016) Safety and efficacy of solitaire stent thrombectomy: individual patient data meta-analysis of randomized trials. Stroke 47(3):798–806PubMedPubMedCentral

108.

Schönenberger S, Henden PL, Simonsen CZ et al (2019) Association of general anesthesia vs procedural sedation with functional outcome among patients with acute Ischemic stroke undergoing thrombectomy: a systematic review and meta-analysis. JAMA 322(13):1283–1293PubMedPubMedCentral

109.

Maier B, Delvoye F, Labreuche J et al (2020) Impact of blood pressure after successful endovascular therapy for anterior acute Ischemic stroke: a systematic review. Front Neurol 11:573382PubMedPubMedCentral

110.

Maier B, Fahed R, Khoury N et al (2019) Association of blood pressure during thrombectomy for acute Ischemic stroke with functional outcome: a systematic review. Stroke 50(10):2805–2812PubMed

111.

Qin J, Zhang Z (2020) Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta-analysis. Brain Behav. https://doi.org/10.1002/brb3.1898CrossRefPubMedPubMedCentral

112.

Liu X, Dai Q, Ye R et al (2020) Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol 19(2):115–122PubMed

113.

Ng LK, Nimmannitya J (1970) Massive cerebral infarction with severe brain swelling: a clinicopathological study. Stroke 1(3):158–163PubMed

114.

Hacke W, Schwab S, Horn M et al (1996) ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53(4):309–315PubMed

115.

Simard JM, Kent TA, Chen M et al (2007) Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol 6(3):258–268PubMedPubMedCentral

116.

Vahedi K, Hofmeijer J, Jüttler E et al (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6(3):215–222PubMed

117.

Zhao J, Su YY, Zhang Y et al (2012) Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocrit Care 17(2):161–171PubMed

118.

Jüttler E, Unterberg A, Woitzik J et al (2014) Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med 370(12):1091–1100PubMed

119.

Yu JW, Choi JH, Kim DH et al (2012) Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 70 years old. J Cerebrovasc Endovasc Neurosurg 14(2):65–74PubMedPubMedCentral

120.

Wijdicks EF, Sheth KN, Carter BS et al (2014) Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45(4):1222–1238PubMed

121.

Kuczynski AM, Ospel JM, Demchuk AM et al (2020) Therapeutic hypothermia in patients with malignant Ischemic stroke and hemicraniectomy—a systematic review and meta-analysis. World Neurosurg 141:e677–e685PubMed

122.

Chen Z, Zhang X, Liu C (2020) Outcomes of therapeutic hypothermia in patients treated with decompressive craniectomy for malignant Middle cerebral artery infarction: a systematic review and meta-analysis. Clin Neurol Neurosurg 188:105569PubMed

123.

Bushnell C, Howard VJ, Lisabeth L et al (2018) Sex differences in the evaluation and treatment of acute ischaemic stroke. Lancet Neurol 17(7):641–650PubMed

124.

Girijala RL, Sohrabji F, Bush RL (2017) Sex differences in stroke: review of current knowledge and evidence. Vasc Med 22(2):135–145PubMed

Titel: S2e-Leitlinie: Akuttherapie des ischämischen Schlaganfalls
Kurzfassung der Leitlinie der Deutschen Gesellschaft für Neurologie
verfasst von: Prof. Dr. Peter A. Ringleb
Prof. Dr. Martin Köhrmann
die Leitlinien-Gruppe
Publikationsdatum: 17.01.2022
Verlag: Springer Medizin
Schlagwort: Apoplex
Erschienen in: DGNeurologie / Ausgabe 1/2022
Print ISSN: 2524-3446
Elektronische ISSN: 2524-3454
DOI: https://doi.org/10.1007/s42451-021-00407-6

Passend zum Thema

Leitlinien-Update und neue Pocket-Leitlinie vorgestellt von Prof. Möllmann

Vorhofflimmern

Die neue Leitlinie zur Behandlung von Herzklappenerkrankungen der European Society of Cardiology (ESC) und der European Association for Cardio-Thoracic Surgery (EACTS) ist ab jetzt als deutschsprachige Pocket-Leitlinien abrufbar. Die wichtigsten Neuerungen des Updates finden Sie hier von Prof. Dr. Helge Möllmann aus Dortmund für Sie zusammengefasst.

Expertenrat: Wer profitiert vom Vorhofohr-Verschluss

Vorhofflimmern

Der interventionelle Verschluss des linken Vorhofohrs ist eine in den Leitlinien empfohlene Alternative zur oralen Antikoagulation bei Menschen mit Vorhofflimmern. Bei welchen Patientinnen und Patienten Sie konkret an diese Alternative denken sollten – dazu gibt Kardiologe PD Dr. Zisis Dimitriadis alltagstaugliche Tipps.

Abbott Structural Heart

Content Hub

Wir helfen Menschen mit Strukturellen Herzerkrankungen ihre Lebensqualität zu verbessern. Entdecken Sie unser einzigartiges Produktportfolio für ihre Patienten.

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Auszug

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2022

Magazin

Kostenloser Anspruch auf Kopie der Patientenakte?

Unterscheidung psychogener nicht-epileptischer und epileptischer Anfälle

Episignaturen als neues Werkzeug für die Diagnostik

Akute Verwirrtheit nach FSME-Infektion

Status epilepticus bei Erwachsenen

Passend zum Thema

Leitlinien-Update und neue Pocket-Leitlinie vorgestellt von Prof. Möllmann

Expertenrat: Wer profitiert vom Vorhofohr-Verschluss

Abbott Structural Heart