Kernaussagen
Der Schlaganfall ist ein medizinischer Notfall und bedarf einer unverzüglichen, gezielten
Therapie. Zertifizierte Stroke Units bieten die dafür erforderliche Infrastruktur.
Die wichtigsten Ursachen des ischämischen Schlaganfalls sind die zerebrale Makroangiopathie,
kardiale Emboliequellen (insbesondere Vorhofflimmern) und die zerebrale Mikroangiopathie.
Die intravenöse Lyse ist zugelassen innerhalb von 3 h nach Symptombeginn. In den ersten
1,5 h ist sie am wirkungsvollsten (NNT = 4). Innerhalb von 3 – 4,5 h sollte sie vorerst
als individueller Heilversuch durchgeführt werden. Vor einer Lyse ist eine zerebrale
Bildgebung immer zwingend erforderlich.
Patienten mit akuten embolischen Verschlüssen der proximalen zerebralen Arterien sollten
in den ersten 6 h einer mechanischen Rekanalisierung durch intraarterielle neuroradiologische
Intervention zugeführt werden.
Patienten über 60 Jahre mit ausgedehnten Infarkten im Stromgebiet der A. cerebri media
(„Zwei-Drittel-Mediainfarkt“) profitieren von einer dekompressiven Hemikraniektomie
(osteoklastische Trepanation) innerhalb der ersten 48 – 72 h nach Symptombeginn.
Die sekundärprophylaktische Karotis-TEA ab einem Stenosegrad von ≥ 70 % ist der medikamentösen
Sekundärprophylaxe überlegen, wenn das periinterventionelle Risiko unter 6 % liegt.
Eine sekundärprophylaktische Implantation von Karotisstents kann derzeit außerhalb
von Studien nicht empfohlen werden.
Neue Therapieverfahren sowohl in der Akutphase (Sonothrombolyse) als auch in der Sekundärprophylaxe
(direkte Thrombin- und Faktor-Xa-Antagonisten) werden derzeit etabliert.
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Dr. med. Johannes M. Albers
Klinik und Poliklinik für Neurologie
Universitätsklinikum Münster
Albert-Schweitzer-Straße 33
48149 Münster
Phone: +49(0)251/83-48231
Fax: +49(0)251/83-45847
Email: albersjo@uni-muenster.de
