Rekanalisationstherapien beim akuten Schlaganfall

Zusammenfassung

In der Frühphase des Schlaganfalls können neben der intravenösen Lyse verschiedene endovaskuläre Methoden zur Gefäßrekanalisation eingesetzt werden. Die mechanischen Rekanalisationsmethoden haben den Vorteil, dass sie auch bei Lysekontraindikationen und nach erfolgloser i. v. Lyse verwendet werden können; das therapeutische Zeitfenster ist breiter als bei der i. v. Lyse, und es sind unmittelbar nach der Intervention deutlich höhere Rekanalisationsraten nachweisbar. Der bestehenden Diskrepanz zwischen den hohen Gefäßeröffnungsraten und dem klinischen Outcome kann entscheidend durch eine verbesserte Patientenselektion begegnet werden. Im Rahmen dieser Übersicht werden die derzeit wichtigsten Rekanalisationstherapien vorgestellt. Die aktuelle Studienlage und der Stellenwert der Behandlungsmethoden werden anhand der Hauptindikationen zur mechanischen Rekanalisation – dem Mediahauptstammverschluss, dem Carotis-T-Verschluss und der Basilaristhrombose – erörtert.

Summary

In the acute stroke therapy several interventional methods are available for the recanalization of arteries in addition to intravenous thrombolysis. Endovascular therapy primarily offers the following advantages: it can be used when thrombolysis is contraindicated as well as after unsuccessful intravenous thrombolysis, the therapeutic time window exceeds that of intravenous thrombolysis, and significantly higher recanalization rates are achieved. However, there is generally a discrepancy between vessel recanalization rates and clinical patient outcome.A better patient selection might counteract this imbalance in the future. This overview outlines the most important current recanalization therapies. Furthermore, a review of current studies is presented and the value of the methods of treatment is discussed with respect to the main indications for the recanalization therapy, the occlusions of the middle cerebral artery, carotid-T and basilar artery.

Schlüsselwörter

Schlaganfall - Rekanalisationstherapie - mechanische Rekanalisation - Lysetherapie

Keywords

Stroke - recanalization therapy - mechanical recanalization - lysis

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