Akuttherapie des ischämischen Schlaganfalls – Rekanalisierende Therapie^[*]

Zusammenfassung

Hintergrund: Ziel dieses Manuskripts ist ein Update der DGN-Leitlinie zu rekanalisierenden Therapien bei Patienten mit akutem Hirninfarkt, was sowohl die systemische Thrombolyse als auch die mechanische Rekanalisation umfasst. Dies ist Teil der Gesamtüberarbeitung der Leitlinie „Akuttherapie des Hirninfarkte“ (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., AWMF-Register Nr. 030-046), wurde aber wegen der Relevanz vorab erstellt.

Methodik: Dieses fokussierte Update nimmt Stellung zu den beiden Fragen (1) „Welche Patienten mit akutem Hirninfarkt sollen mit einer systemischen Thrombolyse behandelt werden?“ und (2) „Welche Schlaganfallpatienten mit akutem Hirninfarkt sollten mit einer mechanischen Thrombektomie behandelt werden?“. Es ist nicht vorgesehen eine vollständige systematische Literaturanalyse zu erstellen, weswegen eine Leitlinie auf dem S2k-Niveau nach den Standards der AWMF erstellt wurde. Sechs nominierte Mitglieder der Deutschen Gesellschaft für Neurologie (DGN), der Deutschen Schlaganfallgesellschaft (DSG) und der Deutschen Gesellschaft für Neuroradiologie (DGNR) waren an der Formulierung der Leitlinie beteiligt. Die Vorstände der Fachgesellschaften stimmten der Leitlinie zu. Die Regeln der AWMF und der DGN zum Umgang mit potenziellen Interessenkonflikten wurden während des Konsensprozesses gewahrt.

Ergebnis: Es werden konsensusbasierte Leitlinienempfehlungen zur Selektion von Patienten für die systemische Thrombolyse und die mechanische Rekanalisation vorgestellt, außerdem auch zur Durchführung der Prozeduren.

Schlussfolgerung: Die Empfehlungen dieser Leitlinie können Unsicherheiten bezüglich rekanalisierender Therapiemöglichkeiten bei akuten Schlaganfallpatienten reduzieren und insbes. zur Verbreitung effektiver und sicherer endovaskulärer Techniken beitragen.

Abstract

Purpose: The aim was to provide an update of the current guideline recommendations of the German Neurological Society (DGN) for recanalisation therapy of acute ischemic stroke focusing on systemic thrombolysis and mechanical thrombectomy. This document is part of the update of the entire guideline for acute stroke treatment (AWMF-No 030-046). It was prepared in advance because of major recent developments in this area.

Methods: This update focuses on the two questions: (1) “Which patients with acute ischemic stroke should be treated with systemic thrombolysis?” (2) “Which patients with acute ischemic stroke should be treated with thrombectomy?” It is not intended to provide a complete literature review. The guideline was prepared at an S2k-level according to the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., AWMF) standards. Accordingly, it does not include a formalized, comprehensive literature review. Six nominated members of the German Neurology Society, the German Stroke Society and the German Society of Neuroradiology, respectively, were involved in the update. The executive committees of these societies approved the guideline. Adherence to the AWMF and the DGN conflict of interest policy was assured throughout the consensus process.

Results: Consensus-based guidelines are presented for the selection of patients with acute ischemic stroke for systemic and endovascular treatment, as well as for the performance of respective procedures.

Conclusion: These guideline recommendations are intended to reduce uncertainties regarding recanalisation therapy in acute ischemic stroke patients, and, in particular, should facilitate implementation of effective and safe endovascular stroke treatment in current clinical practice.

Schlüsselwörter

Leitlinie - akute Schlaganfallbehandlung - systemische Thrombolyse - endovaskuläre Schlaganfalltherapie - mechanische Thrombektomie

Keywords

guideline - acute stroke treatment - systemic thrombolysis - endovascular stroke treatment - mechanical thrombectomy

^* Den Leitlinientext zusammen mit der Interessenkonflikterklärung sowie dem Methodenreport finden Sie auch auf www.dgn.org/leitlinien sowie www.awmf.de.

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