Versorgung des akuten ischämischen Schlaganfalls

Zusammenfassung

Die Akutversorgung des ischämischen Schlaganfalls umfasst Maßnahmen wie Diagnosesicherung, Basismaßnahmen der Erstversorgung und Indikationstellung für spezifische Therapien.

Viele Therapieoptionen sind in ihrem Wirkungsgrad zeitabhängig. Deshalb sind Zeitverzögerungen in der Versorgungskette von Nachteil. Die stationäre Versorgung erfolgt durch das geschulte, multidisziplinäre Personal der spezialisierten Schlaganfallstation (Stroke Unit). Auch technische Möglichkeiten beeinflussen die Therapieoptionen. Eine zentrale Rolle kommt dabei der zerebralen Bildgebung zu.

Evidenzbasiert sind folgende fünf Therapien: Behandlung auf der Stroke Unit, Thrombolyse innerhalb von 4,5 h nach Symptombeginn, mechanische Rekanalisation bei Verschlussnachweis in einem proximalen, intrakraniellen Gefäß, frühe Gabe von ASS sowie die Hemikraniektomie bei Patienten mit sogenannten malignen Infarkten

Im folgenden Beitrag werden die notwendige Akutdiagnostik, sowie die allgemeinen und spezifischen Therapieoptionen dargestellt, welche die Versorgung innerhalb der ersten 72 h bestimmen.

Abstract

Targets of acute ischemic stroke management include verification of clinical diagnosis, start of basic care and decision-making about specific treatments.

Effectiveness of most therapeutic options is time dependent. Time delays within the rescue chain are associated with worse outcome. Trained and multidisciplinary teams on Stroke Unit form the backbone of acute management. Moreover, technical infrastructure influences therapeutic options. Cerebral imaging is pivotal.

The following five therapies are evidence-based: treatment on a stroke unit, thrombolysis within 4.5hrs after symptom onset, mechanical recanalization in patients with occlusion of proximal, intracranial arteries, early administration of Aspirin, and hemicraniectomy in patients with so-called malignant infarction.

This article describes the necessary diagnostic steps and specific as well as non-specific therapeutic options that compose acute management within the first 72 hours.

Schlüsselwörter

akuter ischämischer Schlaganfall - Apoplex - Hirninfarkt - Notfallmanagement - Review

Keywords

acute cerebral infarction - apoplexy - stroke - emergency medical management - review

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