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Hamostaseologie 2020; 40(01): 022-030
DOI: 10.1055/s-0039-1700502
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Causes and Secondary Prevention of Acute Ischemic Stroke in Adults

Märit Jensen
1   Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
Götz Thomalla
1   Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

05 August 2019

10 September 2019

Publication Date:
24 October 2019 (online)

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Abstract

Stroke still remains a major cause of death and disability worldwide. Ischemic stroke is the most common type of stroke. Causes of ischemic stroke can be classified into large-artery atherosclerosis, cardiogenic embolism, small-vessel disease, stroke of other determined etiology, and stroke of undetermined etiology. Stroke causes in adults are mainly attributable to classical cardiovascular risk factors such as hypertension, diabetes, hypercholesterolemia, and smoking. In neuroimaging, stroke subtypes can be defined according to lesion localization and distribution (territorial infarct, lacunar infarct, hemodynamic infarct), which provide information as to the underlying etiology. Acute stroke management comprises rapid neurological assessment and rapid imaging to initiate effective reperfusion treatment with intravenous thrombolysis and mechanical thrombectomy. Stroke survivors are at increased risk of recurrent stroke. Therefore, diagnosis of the underlying cause and optimal secondary prevention is of importance. Pharmacologic secondary prevention includes antithrombotic therapy with antiplatelet drugs, oral anticoagulation, and treatment of vascular risk factors. Nonpharmacologic measures of secondary prevention comprise surgical or interventional revascularization of symptomatic carotid stenosis and interventional closure of patent foramen ovale.

Zusammenfassung

Der Schlaganfall beim Erwachsenen stellt weiterhin weltweit eine der häufigsten Ursachen für Tod und Behinderung dar. Der ischämische Schlaganfall ist die häufigste Unterform und kann verschiedenen Ursachen zugeordnet werden: Makroangiopathie, kardiale Embolie, Mikroangiopathie, andere Ätiologie und unbekannte Ätiologie. Die zuvor beschriebenen Ursachen sind assoziiert mit den klassischen kardiovaskulären Risikofaktoren arterielle Hypertonie, Diabetes mellitus, Hypercholesterinämie und Rauchen. In der zerebralen Bildgebung lassen sich Schlaganfallläsionen nach Lokalisation und Verteilungen klassifizieren (territorial, lakunär, hämodynamisch), welche Hinweise auf die zugrundeliegende Ätiologie geben können. Die Akuttherapie des Schlaganfalls umfasst neben der schnellen neurologischen Untersuchung die rasche Bildgebung, um nach Ausschluss einer Blutung die weitere Akuttherapie mittels intravenöser Thrombolyse und mechanischer Rekanalisation einzuleiten. Entscheidend für die Vermeidung eines erneuten Schlaganfalls ist die umfassende Ursachendiagnostik als Basis für eine effektive Sekundärprophylaxe. Zur medikamentösen Sekundärprophylaxe zählen in erster Linie die Thrombozytenaggregationshemmung, die orale Antikoagulation und die Behandlung der kardiovaskulären Risikofaktoren. Darüber hinaus kommen als nicht-medikamentöse Maßnahmen der Sekundärprophylaxe die operative oder interventionelle Revaskularisierung einer symptomatischen Carotisstenose und der Verschluss eines persistierenden Foramen ovale in Frage.

Keywords

ischemic stroke - etiology - secondary prevention

Schlüsselwörter

ischämischer Schlaganfall - Schlaganfallursachen - Sekundärprophylaxe
 

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