Hirnstamminsult: Bildgebende Diagnostik und endovaskuläre Therapiekonzepte

Zusammenfassung

In dieser Übersichtsarbeit wird auf die gefäßanatomischen und pathophysiologischen Grundlagen des Hirnstamminfarktes sowie auf die oft wegweisenden klinischen Syndrome eingegangen. Darüber hinaus wird anhand der Literatur dargestellt, welche Wertigkeit die verschiedenen invasiven und nichtinvasiven bildgebenden Verfahren (Ultraschall, MRT, MRA, CT, CTA, DSA) zur Erkennung einer Hirnstammischämie haben. Studienergebnisse zu den gefäßrekanalisierenden Methoden (lokale intraarterielle Fibrinolyse, mechanische Rekanalisierungsverfahren, Thrombozyteninhibition) in der Behandlung der akuten vertebrobasilären Thrombose sowie endovaskuläre Verfahren zur Prophylaxe der vertebrobasilären Ischämie (Angioplastie und Stent-Angioplastie der hirnzuführenden Arterien) werden vorgestellt.

Abstract

This review article describes the vascular anatomy and pathophysiology of the vertebrobasilar ischaemia as well as the most important clinical syndromes of brainstem infarctions. An overview of the literature presents the role of invasive and non-invasive techniques (ultrasound, MRI, MRA, CT, CTA, intraarterial angiography) to diagnose an acute brainstem infarction. Current concepts are described for treating acute vertebrobasilar thrombosis, including local intraarterial fibrinolysis, mechanical recanalization and medical treatment, and for preventing brainstem infarction, including angioplasty and stent-assisted angioplasty of the brainstem supplying arteries.

Brainstem - Acute stroke - Diagnosis - Endovascular therapy - Thrombolysis - Vertebrobasilar ischemia

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