Mechanische Thrombektomie bei akuten Schlaganfällen – Aktueller Stand und Ausblick

Lernziele

In diesem Beitrag soll in übersichtlicher Form zusammengefasst werden, welche Patienten für eine endovaskuläre Therapie des Schlaganfalls infrage kommen und wie das periprozedurale Management gestaltet werden kann. Zusätzlich werden Kenntnisse der gängigen interventionellen Techniken vermittelt.

• Literatur

• 1 Hacke W, Kaste M, Fieschi C et al. Randomized Double-Blind Placebo-Controlled Trial of Thrombolytic Therapy with Intravenous Alteplase in Acute Ischaemic Stroke (ECASSII). Lancet 1998; 352: 1245-1251
• 2 The National Institute Of Neurological Disorders And Stroke rtPA Stroke Study Group. Tissue Plasminogen Activator for Acute Ischemic Stroke. New Engl J Med 1995; 333: 1581-1587
• 3 Wolpert S, Brückmann H, Greenlee R et al. Neuroradiologic Evaluation of Patients with Acute Stroke Treated with Recombinant Tissue Plasminogen Activator. Am J Neuroradiol 1993; 14: 3-13
• 4 Furlan A, Higashida R, Wechsler L et al. Intra-arterial Prourokinase for Acute Ischemic Stroke. JAMA 1999; 282: 2003-2011
• 5 Tomsick T, Broderick J, Carrozella J et al. Revascularization Results in the Interventional Management of Stroke II Trial. Am J Neuroradiol 2008; 29: 582-587
• 6 Smith W, Sung G, Starkman S et al. Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke – Results oft he MERCI Trial. Stroke 2005; 36: 1432-1440
• 7 Smith W, Sung G, Saver G et al. Mechanical Thrombectomy for Acute Ischemic Stroke – Final Results of the Multi MERCI Trial. Stroke 2008; 39: 1205-1212
• 8 Bose A, Henkes H, Alfke K et al. The Penumbra System: A Mechanical Device for the Treatment of Acute Stroke due to Thrombembolism. Am J Neuroradiol 2008; 29: 1409-1413
• 9 The Penumbra Pivotal Stroke Trial Investigators. The Penumbra Pivotal Stroke Trial – Safety and Effectiveness of a New Generation of Mechanical Devices for Clot Removal in Intracranial Large Vessel Occlusive Disease. Stroke 2009; 40: 2761-2768
• 10 Perez M, Miloslavski E, Fischer S et al. Intracranial Thrombectomy Using the Solitaire Stent: a Historical Vignette. J Neurointerv Surg 2011; Dec 14 (Epub ahead of print)
• 11 Nogueira R, Lutsep H, Gupta R et al. Primary Results of the Trevo2 Trial. Oral Presentation at the European Stroke Conference. Lisbon: 2012
• 12 Saver J. SWIFT: Lessons from a Deep Data Dive. Oral Presentation at the European Stroke Conference. Lisbon: 2012
• 13 Levy E, Siddiqui A, Crumlish A et al. First Food and Drug Administration-Approved Prospective Trial of Primary Intracranial Stenting for Acute Stroke SARIS (Stent-Assisted Recanalization in Acute Ischemic Stroke). Stroke 2009; 40: 3552-3556
• 14 Ogawa A, Mori E, Minematsu K et al. Randomized Trial of Intraarterial Infusion of Urokinase within 6 Hours of Middle Cerebral Artery Stroke. The Middle Cerebral Artery Embolism Local Fibrinolytic Intervention Trial (MELT) Japan. Stroke 2007; 38: 2633-2639
• 15 Costalat V, Machi P, Kyriakos L et al. Rescue, Combined and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study. Timing, Safety and Efficacy. Stroke 2011; 42: 1929-1935
• 16 Bhatia R, Hill M, Shobha N et al. Low Rates of Acute Recanalization with Intravenous Recombinant Tissue Plasminogen Activator in Ischemic Stroke Real-World Experience and a Call for Action. Stroke 2010; 41: 2254-2258
• 17 Kimura K, Iguchi Y, Shibazaki K et al. Early Recanalization Rate of Major Occluded Brain Arteries after Intravenous Tissue Plasminogen Activator Therapy Using Serial Magnetic Resonance Studies. Eur Neurol 2009; 62: 287-292
• 18 Riedel C, Zimmermann P, Jensen-Kondering U et al. The Importance of Size: Successful Recanalization by Intravenous Thrombolysis in Acute Anterior Stroke Depends on Thrombus Length. Stroke 2011; 42: 1775-1777
• 19 Schonewille W, Wijman C, Michel P et al. Treatment and Outcomes of Acute Basilar Artery Occlusion in the Basilar Artery International Cooperation Study (BASICS): A Prospective Registry Study. Lancet Neurol 2009; 8: 724-730
• 20 Bang O, Saver J, Buck B et al. Impact of Collateral Flow on Tissue Fate in Acute Ischemic Stroke. J Neurol Neurosurg Psy 2008; 79: 625-629
• 21 Siemonsen S, Fitting T, Thomalla G et al. Visual Assessment of Magnetic Resonance Imaging Perfusion Lesions in a Large Patient Group. Clin Neuroradiol 2012; Apr 8 (Epub ahead of print)
• 22 Campbell BC, Christensen S, Foster S et al. Visual Assessment of Perfusion-Diffusion Mismatch is Inadequate to Select Patients for Thrombolysis. Cerebrovasc Dis 2010; 29: 592-596
• 23 Lansberg M on behalf of the DEFUSE-2 Investigators. Oral presentation at the European Stroke Conference. Lisbon: 2012
• 24 Wintermark M, Flanders A, Velthuis B et al. Perfusion CT Assessment of Infarct Core and Penumbra: Receiver Operating Characteristics Curve Analysis in 130 Patients Suspected of Acute Hemispheric Stroke. Stroke 2006; 37: 979-985
• 25 Willey J, Stillman J, Rivolta J et al. Too Good to Treat? Outcomes in Patients not Receiving Thrombolysis Due to Mild Deficits or Rapidly Improving Symptoms. Int J Stroke 2012; 7: 202-206
• 26 Nedeltchev K, Schwengler B, Haefeli T et al. Outcome of Stroke With Mild or Rapidly Improving Symptoms. Stroke 2007; 38: 2531-2535
• 27 Rajajee V, Kidwell C, Starkman S et al. Early MRI and Outcomes of Untreated Patients with Mild or Improving Ischemic Stroke. Neurology 2006; 67: 980-984
• 28 Ashdagi N, Butcher K, Hill M. Risks and Benefits of Thrombolysis in the Elderly. Int J Stroke 2012; 7: 142-149
• 29 The IST-3 Collaborative Group. The Benefits and Harms of Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator within 6h of Acute Ischaemic Stroke The Third International Stroke Trial (IST-3): a Randomized Controlled Trial. Lancet 2012; May 23 (Epub ahead of print)
• 30 Galimanis A, Jung S, Mono M et al. Endovascular Therapy of 623 Patients with Anterior Circulation Stroke. Stroke 2012; 43: 1052-1057
• 31 Nogueira R, Liebeskind D, Sung G et al. Predictors of Good Clinical Outcomes, Mortality and Successful Revascularization in Patients with Acute Ischemic Stroke Undergoing Thrombectomy. Stroke 2009; 40: 3777-3783
• 32 Smith W for the Multi MERCI Investigators Safety of Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Results oft he Multi Mechanical Embolus Removal in Cerebral Ischemica (MERCI) Trial, Part I. Am J Neuroradiol 2006; 27: 1177-1182
• 33 Pfefferkorn T, Holtmannspötter M, Patzig M et al. Preceding Intravenous Thrombolysis Faciliates Endovascular Mechanical Recanalization in Large Intracranial Artery Occlusion. Int J Stroke 2011; 7: 14-18
• 34 Abou-Chebl A, Lin R, Hussain M et al. Conscious Sedation Versus General Anaethesia During Endovascular Therapy for Acute Anterior Circulation Stroke: Preliminary Results from a Retrospective, Multicenter Study. Stroke 2010; 41: 1175-1179
• 35 Jumaa M, Zhang F, Ruiz-Ares G et al. Comparison of Safety and Clinical and Radiographic Outcomes in Endovascular Acute Stroke Therapy for Proximal Middle Cerebral Artery Occlusion with Intubation and General Anaethesia Versus the Nonitubated State. Stroke 2010; 41: 1180-1184
• 36 Davies M, Menon B, Baghirzada L et al. Anaesthetic Management and Outcome in Patients During Endovascular Therapy for Acute Stroke. Anethesiology 2012; 116: 396-405