Interventionelle Therapie des Schlaganfalls

Die mechanische Thrombektomie (MT) von Verschlüssen großer Hirngefäße in Kombination mit der systemischen intravenösen Thrombolyse (IVT) hat sich in den letzten Jahren zu einem hocheffektiven evidenzbasierten Verfahren der Akuttherapie des Hirninfarkts entwickelt. Die Chance auf ein behinderungsfreies Überleben der in der Regel schwer betroffenen Patienten wird um ca. 75% erhöht. Allerdings stellt die MT nur für maximal 1-5 % der Patienten mit ischämischem Schlaganfall eine Therapieoption dar. Die Akuttherapie der ischämischen Schlaganfälle fußt daher weiter hauptsächlich auf den etablierten Maßnahmen wie Stroke-Unit-Behandlung, frühe Sekundärprophylaxe und IVT. Die flächendeckende Versorgung der Kandidaten für eine MT stellt eine logistische Herausforderung dar, zu denen auch die Optimierung der interdisziplinären Zusammenarbeit gehört. Die MT hat auch Implikationen für die Akuttherapie oral antikoagulierter Schlaganfallpatienten. Eine moderne Schlaganfallbehandlung erfordert die interdisziplinäre Kooperation von Neurologie, Neuroradiologie, Neurochirurgie, Kardiologie, Gefäßchirurgie und Anästhesie.

Mechanical thrombectomy (MT) of occlusions of large cerebral arteries in combination with systemic intravenous thrombolysis (IVT) has developed during the last years as effective procedure for the acute treatment of ischemic stroke. The chance of a disability-free survival of patients who are usually severely affected is increased by approximately 75 %. However, MT is a therapeutic option for only a maximum of 1-5 % of patients with ischemic stroke. The acute treatment of ischemic stroke is therefore based on established strategies such as stroke-unit treatment, early secondary prophylaxis and IVT. The nationwide coverage of the candidates for an MT bears some logistical challenges, including the optimization of interdisciplinary cooperation. MT also has implications for the acute therapy of patients undergoing oral anticoagulation. Modern stroke treatment requires the interdisciplinary cooperation of neurology, neuroradiology, neurosurgery, cardiology, vascular surgery and anesthesia.

Key words

Stroke - cerebral infarction - mechanical thrombectomy - thrombolysis - structures of supply - interdisciplinarity

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