Die Rolle der zerebralen Bildgebung für die Therapieentscheidung zur Thrombektomie

Zusammenfassung

Sechs aktuelle randomisierte kontrollierte Studien haben einen signifikanten Behandlungseffekt der Thrombektomie auf den klinischen Verlauf bei Patienten mit akutem Schlaganfall aufgrund eines proximalen Gefäßverschlusses im vorderen Stromgebiet gezeigt. Die positiven Ergebnisse dieser Studien müssen jetzt in die klinische Routine übertragen werden. Geeignete Patienten sollten dazu schnell und zuverlässig für eine Thrombektomie evaluiert werden. Alle Studien bestätigten die entscheidende Rolle einer prätherapeutischen Bildgebung in der Auswahl der Patienten, die von einer endovaskulären Therapie profitieren können. Dabei wurden jedoch unterschiedliche bildgebungsbasierte Ansätze mit Darstellung des behandelbaren Gefäßverschlusses, des Infarktkerns, der arteriellen Kollateralversorgung oder der Penumbra gewählt. In dieser Übersichtsarbeit werden anhand der aktuellen Studienlage die verschiedenen Untersuchungs- und Auswertetechniken der nichtinvasiven zerebralen Bildgebung und ihrer Rolle für die Therapieentscheidung zur Thrombektomie beim akuten Schlaganfall diskutiert.

Abstract

Six recent randomized controlled trials showed a significant benefit of endovascular therapy on patient outcome in acute ischemic stroke due to anterior cerebral artery occlusion. The positive results of these trials need to be implemented in clinical routine. Suitable patients should be evaluated for thrombectomy reliably and fast. All trials confirmed the role of pretherapeutic neuroimaging as crucial in selecting patients who can benefit from endovascular therapy. However, different approaches have been used, including imaging of the target vascular occlusion, infarct core, arterial collateral supply or the penumbra. In this review we discuss, in the context of the recent trials, the different methods of non-invasive neuroimaging and their role in decision-making for thrombectomy in acute ischemic stroke.

Schlüsselwörter

Schlaganfall - zerebrale Bildgebung - Thrombektomie

Keywords

stroke - neuroimaging - endovascular thrombectomy

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