Optimierte Rate spezifischer revaskularisierender Therapien beim akuten ischämischen Schlaganfall – was ist das Ziel? Erwägungen anhand der Erfahrungen eines tertiären Versorgungszentrums

Zusammenfassung

Hintergrund: Aufgrund des besseren Verlaufes nach Rekanalisierung und vielversprechender interventioneller Verfahren werden derzeit strukturelle Bemühungen unternommen, die Rate dieser Therapien beim Schlaganfall zu verbessern. Unklar ist, wie und auf welchem Niveau dies optimierbar ist.

Patienten und Methode: Retrospektive unizentrische Analyse aller primär zugewiesener, nach einem strukturierten Behandlungspfad mit multimodaler CT Bildgebung spezifisch rekanalisierend behandelter Schlaganfallpatienten eines tertiären Versorgungszentrums im Zeitraum 1/2010 bis 3/2012.

Ergebnisse: 20 % der Patienten wurden lysiert, etwa 20 % hiervon zusätzlich interventionell behandelt. Bei Off-label-Indikation war die Rate spezifischer Perfusionsbefunde signifikant höher als bei On-label-Lysen. Der kurzzeitige klinische Verlauf war hiervon unabhängig.

Schlussfolgerung: Ein strukturierter Behandlungspfad erlaubt eine hohe Rate an Lysen und Interventionen. Anhand der dargestellten Daten kann eine erste Zielsetzung für die allgemeine Versorgungsrealität formuliert werden (20/20 in 2020).

Abstract

Background: Recanalisation favourably influences outcome in acute stroke. Improved endovascular approaches seem to have higher recanalisation rates than systemic thrombolysis. Substantial efforts have been undertaken to increase the proportion of patients to whom these therapies can be applied. It is still unclear what rates can be realised in a clinical setting.

Patients and Methods: This is a retrospective single-centre analysis of patients with acute ischaemic stroke and specific recanalisation therapy primarily admitted to our tertiary care centre from 1/2010 to 3/2012.

Results: 20 % of patients received systemic thrombolysis, 20 % of these additional endovascular strategies. Pathological multimodal CT patterns were more common in patients not fulfilling the inclusion criteria for thrombolysis. Short-term clinical outcomes were similar in on-label and off-label applications.

Conclusion: Structured clinical pathways including multimodal CT imaging are useful in identifying patients likely to profit from revascularisation therapies. Based upon our data, some realistic aims concerning therapy rates in patients with ischaemic stroke treated in everyday practice may be formulated (20/20 in 2020).

Schlüsselwörter

akuter Schlaganfall - Thrombolyse - Versorgungsforschung - Neurothrombektomie - interventionelle Neuroradiologie

Key words

acute stroke - thrombolysis - health services research - thrombectomy - interventional neuroradiology

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