Nicht medikamentöse Prophylaxe des Schlaganfalls[1]

Zusammenfassung

Obwohl in den letzten Jahren wesentliche Fortschritte in der Akutbehandlung des Schlaganfalls zu verzeichnen sind (Thrombolyse, Behandlung auf der Stroke-Unit, optimierte Frührehabilitation) stellt der Schlaganfall nach wie vor die häufigste zu dauerhafter Behinderung führende Erkrankung dar. Von daher kommt der Primärprävention und einer effektiven – an die Ätiopathogenese des Schlaganfalls angepassten – Sekundärprävention eine wesentliche Bedeutung zu. Neben medikamentösen Behandlungsoptionen (Antihypertensiva, Thrombozyten- funktionshemmer, Antikoagulation bei kardialer Emboliequelle, Statine etc.) gibt es auch zahlreiche und evidenzbasierte nichtmedikamentöse Maßnahmen zur Primär- und Sekundärprävention des Schlaganfalls. Im folgenden wird der aktuelle Stand der nichtmedikamentösen Schlaganfallprophylaxe vorgestellt. Dabei wird im ersten Teil auf den Stellenwert von Übergewicht, Nikotin- und Alkoholkonsum, Vitamingabe, körperlicher Aktivität, Schlaf-Apnoe-Syndrom, psychosozialem Stress und Hormontherapie für das Schlaganfallrisiko eingegangen. Im zweiten Teil werden Effektivität und Indikationen zur Sanierung einer symptomatischen bzw. asymptomatischen Karotisstenose – unter besonderer Berücksichtigung der Daten zur Karotis-PTA – dargestellt.

Abstract

Stroke is still the leading cause of long-term major disability in the developed countries, although several improvements have been achieved in acute stroke therapy (e.g., thrombolysis, stroke-unit treatment, optimised early rehabilitation strategies). Therefore, primary prevention as well as an effective secondary prevention – guided by the etiology and risk factors of stroke –is of particular importance to reduce stroke morbidity. In addition to medical prevention strategies (antihypertensives, thrombocyte inhibitors, anticoagulation in atrial fibrillation, statins, etc.), several, including evidenced-based, non-medical options for the primary and secondary prevention of stroke are available. This review summarises the current status of non-medical prevention measures for stroke. In the first part we focus on the importance of obesity, smoking, alcohol, nutrition, vitamin supplementation, physical activity, sleep-apnea syndrome, psychosocial stress and hormone therapy. In the second part we discuss the indications and efficacy of an invasive treatment of symptomatic and asymptomatic carotid stenosis.

Schlüsselwörter

Schlaganfall - Prävention - nichtmedikamentöse Therapie

Key words

stroke - prevention - non-medical treatment

1 Erstveröffentlichung in Akt Neurol 2008; 35: 302–318.

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1 Erstveröffentlichung in Akt Neurol 2008; 35: 302–318.