Therapeutische Strategien bei akutem ischämischen Hirninfarkt

Zusammenfassung

Der Schlaganfall ist nach dem Myokardinfarkt und malignen Tumoren die dritthäufigste Todesursache in Deutschland. Aber auch wenn der Insult überlebt wird, so droht etwa einem Drittel der Patienten belastende Behinderungen und Pflegebedürftigkeit. Epidemiologische Studien haben gezeigt, dass die Inzidenz bei etwa 200-350 pro 100000 Einwohnern, die Prävalenz bei etwa 600 pro 100000 Einwohnern liegt. In Deutschland sind somit 125000 Menschen pro Jahr von einem Schlaganfall betroffen.

Summary

Stroke is the third most common cause of death following myocardial infarction and malignant tumours. But even when patients survive the insult, roughly one-third are threatened by troublesome impairment and a need for special nursing care. Epidemiological studies have shown an incidence of some 200-350 per 100000 population, with a prevalence of some 600 per 100000. This means that, in Germany, 125000 suffer a stroke every year.

Literatur

• 1 Wong KS, Li H, Lam WWM, Chan YL, Kay R. Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke.  Stroke. 2002;  33 532-536
• 2 Sen S, Oppenheimer SM, Lima J, Cohen B. Risk factors for progression of aortic atheroma in stroke and transient ischemic attack patients.  Stroke. 2002;  33 930-935
• 3 Zeumer H, Freitag HJ, Zanella F. et al. . Local intraarterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (rT-PA).  Neuroradiology. 1993;  35 159-162
• 4 Fieschi C, Argentino C, Lenzi GL. et al. . Therapeutic window for pharmacological treatment in acute focal cerebral ischemia.  Ann. N. Y. Acad. Sci. 1988;  522 662-666
• 5 Pulsinelli W. Pathophysiology of acute ischemic stroke.  Lancet. 1992;  339 16-19
• 6 Sherman DC, Atkinson RP, Chippendale T. et al. . Intravenous ancrod for treatment of acute ischemic stroke: the STAT study: a randomized controlled trail. Stroke treatment with ancrod trail.  JAMA. 2000;  282 2395-2403
• 7 Adams HP Jr.. Emergent use of anticoagulation for treatment of patients with ischemic stroke.  Stroke. 2002;  33 856-861
• 8 Karasch Th. Heparininduzierte Thrombozytopenie (HIT). In: Rieger H, Schoop W (Hrsg.). Klinische Angiologie. Springer Verlag 1998: 535-542
• 9 Toth C, Voll C. Validation of a Weight-Based Nomogram for the Use of Intravenous Heparin in Transient Ischemic Attack or Stroke.  Stroke. 2002;  33 670-674
• 10 Albers GW, Amarenco P, Easton JD. et al. . Antithrombolytic therapy for ischemic stroke. Sixth ACCP Consensus Conference on Antithrombotic Therapy.  Chest. 2001;  119 300-320
• 11 Robert A, Felberg RA, Okon NJ. et al. . Early Dramatic Recovery During Intravenous Tissue Plasminogen Activator Infusion: Clinical Pattern and Outcome in Acute Middle Cerebral Artery Stroke.  Stroke. 2002;  33 1301-1307
• 12 Albers GW, Bates VE, Clark WM. et al. . Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study.  JAMA. 2000;  283 1145-1150
• 13 Donnan GA, Davis SM, Chambers BR. et al. . Trails of streptokinase in severe acute ischemic stroke.  Lancet. 1995;  345 578-579
• 14 Donnan GA, Davis SM, Chambers BR. et al. . Streptokinase for acute ischemic stroke with relationship to time of administration: Australian Streptokinase (ASK) Trail Study Group.  JAMA. 1996;  276 961-966
• 15 Multicenter Acute Stroke Trail - European Study Group . Thrombolytic therapy with streptokinase in acute ischemic stroke.  N. Engl. J. Med. 1996;  335 145-150
• 16 Multicentre acute stroke Trail - Italy (MAST-I) Group . Randomised controlled trail of streptokinase, aspirin, and the combination of both in treatment of acute ischemic stroke.  Lancet. 1995;  346 1509-1514
• 17 The National Institute of Neurological Disorders and Stroke (NINDS) rtPA Stroke Study Group . Tissue plasminogen activator for acute ischemic stroke.  N. Engl. J. Med. 1995;  333 1581-1587
• 18 Hacke W, Kaste M, Fieschi C. et al. . Intravenous thrombolyis with recornbinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS).  JAMA. 1995;  274 1017-1025
• 19 Hacke W, Kaste M, Fieschi C. et al. . Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.  Lancet. 1998;  352 1245-1251
• 20 Larrue V, Kummer R von, Muller A. et al. . Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: A secondary analysis of the European-Australasian Acute Stroke Study (ECASS II).  Stroke. 2001;  32 438-441
• 21 The ATLANTIS Stroke Study Investigators . The ATLANTIS rt-PA (Alteplase) acute stroke trail: final results (1999). 24th American Heart Association International Conference on Stroke and Cerebral Circulation.  Nashville, Tennessee, USA.
• 22 Kidwell CS, Saver JL, Carneado J. et al. . Predictors of hemorrhagic transformation in patients receiving intra-arterial thrombolysis.  Stroke. 2002;  33 717-724
• 23 Albers GW, Clark WM, Madden KP. et al. . ATLANTIS Trial: Results for Patients Treated Within 3 Hours of Stroke Onset.  Stroke. 2002;  33 493-496
• 24 Ringleb PA, Schellinger PD, Schranz C, Hacke W. Thrombolytic therapy within 3 to 6 hours after onset of ischemic stroke: Useful or harmful?.  Stroke. 2002;  33 1437-1441
• 25 Reed SD, Cramer SC, Blough DK. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in communiy hospitals.  Stroke. 2001;  32 1832-1840
• 26 Burnette WC, Nesbit GM, Barnwell SL. Intraarterial thrombolysis for acute stroke. Neuroimag.  Clin. North Am. 1999;  9 491-508
• 27 Zoppo GL del, Higashida RT, Furlan AJ. et al. . A phase II randomized trail of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke.  Stroke. 1998;  29 4-11
• 28 Proact II investigators .PROACT II: Recombinant prourokinase (r-ProUK) in acute cerebral thromboembolism. Initial trail results. 24th American Heart Association International Conference on stroke and cerebral circulation, Nashville, Tennessee, USA
• 29 Kummer von R. Thrombolyse. In: Sartor R (Hrsg.). Neuroradiolgie. Stuttgart, New York: Georg Thieme Verlag 1996: 286-289
• 30 Mohr JP, Orgogozo JM, Harrison M. Metaanalysis of oral nimodipine trails in acute ischemic stroke.  Cerebrovasc. 1994;  4 204-210
• 31 Diener HC, Hacke W, Hennerici M, Radberg J. for the Lubeluzole international study group: Lubeluzole in acute ischemic stroke: A double-blind, placebo-controlled phase II trail.  Stroke. 1996;  27 76-81
• 32 Sydserff SD, Cross AJ, Green AR. The neuroprotective effect of Chlormethiazole on ischemic neuronal damage following permanent cerebral artery occlusion in the rat.  Neurodegeneration. 1995;  4 323-328
• 33 Gross CE, Bednar MM, Howard DB, Sporn MB. Transforming growth factor-beta 1 reduces infarct size after experimental cerebral ischemia in a rabbit model.  Stroke. 1993;  24 558-562
• 34 Meden P, Overgaard K, Pedersen H, Boysen G. Effect of early treatment with tirilazad (U74006F) combined with delayed thrombolytic therapy in rat embolic stroke.  Cerebrovasc.. 1996;  6 141-148
• 35 Deyn de PP, Reuck J de, Deberedt W. et al. . for the PASS Group. Treatment of acute ischemic stroke with piracetam.  Stroke. 1997;  28 2347-2352
• 36 Schrader J.. ACCESS-Study. Veröffentlichung im Druck

1 Stroke Treatment with Ancrod Trial

2 Australian Streptokinase Trial Study Group

3 Multicenter Acute Stroke Trial - European Study Group

4 Multicenter Acute Stroke Trial - Italy

5 European Cooperative Acute Stroke Study

6 Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke

7 Recombinant Prourokinase in Acute Cerebral Thromboembolism

8 Acute Candesartan Cilexetil Evaluation in Stroke Survivors-Study

Anschrift für die Verfasser