Endovaskuläre Behandlung des Schlaganfalls

Zusammenfassung

Standardtherapie des ischämischen Schlaganfalls ist die intravenöse Lyse im 3-Stunden-Fenster. Ist diese Therapie kontraindiziert, kann eine endovaskuläre Behandlung indiziert sein. Häufigstes Verfahren ist die intraarteriellen medikamentösen Thrombolyse mit rt-PA. Zusätzlich werden zunehmend mechanische Verfahren eingesetzt, von denen eine schnellere und effektivere Wirkung erwartet wird. Die mechanische Rekanalisation folgt drei Grundprinzipien: Thrombusaspiration, Thrombusextraktion und Thrombusfrakturierung. Verschiedenen Methoden und Instrumente befinden sich in der klinischen Erprobung, wobei einige eine hohe Effektivität bewiesen. Für eine vergleichende Beurteilung dieser Methoden werden größere Studien notwendig sein. Neben der reinen Rekanalisierung eines zerebralen Gefäßverschlusses kann auch eine akute Stentimplantation als frühe Sekundärprophylaxe notwendig werden.

Summary

Standard therapy of acute ischaemic stroke during the first three hours after symptom onset is intravenous thrombolysis. When contraindications exist, an endovascular approach might be possible. Intraarterial administration of thrombolytic drugs is the most common way. Additionally, there is an increasing use of mechanical tools that are expected to be faster and more effective. Three principles of mechanical thrombolysis are known: aspiration, extraction and fracturing of the thrombus. Different tools were tested clinically and some demonstrated its high efficiency. Larger studies are needed to compare those tools. Apart from recanalization of a cerebral vessel occlusion implantation of a stent might be necessary for prophylaxis of recurrent stroke.

Schlüsselwörter

Schlaganfall - Thrombolyse

Keywords

Stroke - thrombolysis

• Literatur

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