Thrombektomie beim akuten Schlaganfall – Schritt für Schritt

Die kathetergestützte Thrombektomie beim akuten Schlaganfall hat sich zu einer Evidenz-basierten Standardbehandlung entwickelt. Die Durchführung erfordert ein standardisiertes Vorgehen, das für drei Standardtechniken beschrieben wird, um das Verständnis für die Abläufe und technische Durchführung bei Neurologen zu erhöhen.

• Literatur

• 1 Goyal M, Menon BK, van Zwam WH. et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723-1731
• 2 Nogueira RG, Jadhav AP, Haussen DC. et al. for the DAWN Trial Investigators Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378: 11-21
• 3 Ringleb PA, Veltkamp R. et al. Leitlinie Akuttherapie des ischämischen Schlaganfalls – Ergänzung 2015. Rekanalisierende Therapie AWMF 030 – 140. DGN; 2015 online
• 4 Pexman JH, Barber PA, Hill MD. et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001; 22: 1534-1542
• 5 Tahtali D, Bohmann F, Rostek P. et al. Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide. J Vis Exp 2017; 119
• 6 Schönenberger S, Hendén PL, Simonsen CZ. et al. 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 2019; 322: 1283-1293
• 7 Zaidat OO, Mueller-Kronast NH, Hassan AE. et al. Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry. Stroke 2019; 50: 697-704
• 8 Turk AS, Siddiqui A, Fifi JT. et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet 2019; 393: 998-1008
• 9 Maus V, Brehm A, Tsogkas I. et al. Stent retriever placement in embolectomy: the choice of the post-bifurcational trunk influences the first-pass reperfusion result in M1 occlusions. J Neurointerv Surg 2019; 11: 237-240
• 10 Jia B, Feng L, Liebeskind DS. et al. Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis. J Neurointerv Surg 2018; 10: 746-750
• 11 Maus V, Behme D, Kabbasch C. et al. Maximizing First-Pass Complete Reperfusion with SAVE. Clin Neuroradiol 2018; 28: 327-338
• 12 Brehm A, Maus V, Tsogkas I. et al. Stent-retriever assisted vacuum-locked extraction (SAVE) versus a direct aspiration first pass technique (ADAPT) for acute stroke: data from the real-world. BMC Neurology 2019; 19: 65
• 13 Osama O, Zaidat OO, Bozorgchami H. et al. Primary Results of the Multicenter ARISE II Study(Analysis of Revascularization in Ischemic Stroke With EmboTrap). Stroke 2018; 49: 1107-1115
• 14 Noser EA, Shaltoni HM, Hall CE. et al. Aggressive mechanical clot disruption: a safe adjunct to thrombolytic therapy in acute stroke?. Stroke 2005; 36: 292-296
• 15 Liebeskind DS, Bracard S, Guillemin F. et al. eTICI reperfusion: defining success in endovascular stroke therapy. J NeuroIntervent Surg 2019; 11: 433-438