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Nervenheilkunde 2014; 33(01/02): 16-24
DOI: 10.1055/s-0038-1627667
Südwestdeutscher Schlaganfalltag
Schattauer GmbH

Sekundärprophylaxe des ischämischen Schlaganfalls

UpdateSecondary prophylaxis of ischaemic strokeUpdate
L. Breuer
1   Neurologische Klinik der Universitätsklinik Erlangen
,
S. Schwab
1   Neurologische Klinik der Universitätsklinik Erlangen
› Institutsangaben
Weitere Informationen

Publikationsverlauf

eingegangen am: 28. August 2013

angenommen am: 03. September 2013

Publikationsdatum:
23. Januar 2018 (online)

    Lizenzen und Reprints

Zusammenfassung

In dieser Übersichtsarbeit werden Neuerungen zu ausgesuchten Themen aus dem Bereich der Sekundärprophylaxe des ischämischen Schlaganfalles vorgestellt. Sowohl die kontrovers diskutierte Behandlung des persistierenden Foramen ovale, die medikamentöse und interventionelle Behandlung intra-kranieller Gefäßstenosen als auch die Detektion und Sekundärprophylaxe des Vorhofflimmerns stehen im Vordergrund. Es wird zudem auf die Rolle der direkten oralen Antikoagulanzien in der Sekundärprophylaxe des nicht valvulären Vorhofflimmerns und auf die Diskussion über einen interventionellen Verschluss des linken Vorhofohres eingegangen. Anhand der Literatur werden aktuelle Entwicklungen dargestellt und diskutiert.

Summary

Based on recent literature this review article describes selected contemporary issues and current trends concerning secondary prophylaxis of ischaemic stroke. Besides the contentious issue of how to treat patent foramen ovale, medical and interventional therapy of intracranial stenosis as well as detection and secondary prophylaxis of atrial fibrillation are discussed. Furthermore this article describes the debate on closure of the left atrial appendage and characterizes the status of the new oral anticoagulant drugs in secondary prophylaxis of non-valvular atrial fibrillation.

Schlüsselwörter

Persistierendes Foramen ovale - Vorhofohrverschluss - intrakranielle Gefäßstenosen - Vorhofflimmern - neue orale Antikoagulanzien

Keywords

Patent foramen ovale - closure of the left atrial appendage - intracranial stenosis - nonvalvular atrial fibrillation - new oral anticoagulant drugs
 

  • Literatur

  • 1 Petty GW. et al. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke 1999; 30 (12) 2513-6.
    CrossrefPubMedGoogle Scholar
  • 2 Sacco RL. et al. Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Annals of neurology 1989; 25 (04) 382-90.
    CrossrefPubMedGoogle Scholar
  • 3 Agmon Y. et al. Frequency of atrial septal aneurysms in patients with cerebral ischemic events. Circulation 1999; 99 (15) 1942-4.
    CrossrefPubMedGoogle Scholar
  • 4 Mattioli AV. et al. Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study. European heart journal 2001; 22 (03) 261-8.
    CrossrefPubMedGoogle Scholar
  • 5 Pearson AC. et al. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. Journal of the American College of Cardiology 1991; 18 (05) 1223-9.
    CrossrefPubMedGoogle Scholar
  • 6 Homma S. et al. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation 2002; 105 (22) 2625-31.
    CrossrefPubMedGoogle Scholar
  • 7 Lamy C. et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke 2002; 33 (03) 706-11.
    CrossrefPubMedGoogle Scholar
  • 8 Serena J. et al. Recurrent stroke and massive rightto-left shunt: results from the prospective Spanish multicenter (CODICIA) study. Stroke 2008; 39 (12) 3131-6.
    CrossrefPubMedGoogle Scholar
  • 9 Handke M. et al. Patent foramen ovale and cryptogenic stroke in older patients. The New England journal of medicine 2007; 357 (22) 2262-8.
    CrossrefPubMedGoogle Scholar
  • 10 Mas J-L. et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. New England Journal of Medicine 2001; 345 (24) 1740-6.
    CrossrefPubMedGoogle Scholar
  • 11 Carroll JD. et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. The New England journal of medicine 2013; 368 (12) 1092-100.
    CrossrefPubMedGoogle Scholar
  • 12 Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW. et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. The New England journal of medicine 2012; 366 (11) 991-9.
    CrossrefPubMedGoogle Scholar
  • 13 Meier B. et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. The New England journal of medicine 2013; 368 (12) 1083-91.
    CrossrefPubMedGoogle Scholar
  • 14 Sacco RL. et al. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995; 26 (01) 14-20.
    CrossrefPubMedGoogle Scholar
  • 15 Wityk RJ. et al. Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 1996; 27 (11) 1974-80.
    CrossrefPubMedGoogle Scholar
  • 16 Chimowitz MI. et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. The New England journal of medicine 2005; 352 (13) 1305-16.
    CrossrefPubMedGoogle Scholar
  • 17 Abou-Chebl A, Bashir Q, Yadav JS. Drug-eluting stents for the treatment of intracranial atherosclerosis: initial experience and midterm angiographic follow-up. Stroke 2005; 36 (12) e165-8.
    CrossrefPubMedGoogle Scholar
  • 18 Fiorella D. et al. US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke 2007; 38 (03) 881-7.
    CrossrefPubMedGoogle Scholar
  • 19 Gomez CR. et al. Elective stenting of symptomatic middle cerebral artery stenosis. AJNR 2000; 21 (05) 971-3.
    PubMedGoogle Scholar
  • 20 Hartmann M, Jansen O. Angioplasty and stenting of intracranial stenosis. Current opinion in neurology 2005; 18 (01) 39-45.
    CrossrefPubMedGoogle Scholar
  • 21 Lee CY, Yim MB. Primary stent therapy for symptomatic intracranial atherosclerotic stenosis: 1-year follow-up angiographic and midterm clinical outcomes. Journal of neurosurgery 2006; 105 (02) 235-41.
    CrossrefPubMedGoogle Scholar
  • 22 Lylyk P. et al. Endovascular reconstruction by means of stent placement in symptomatic intracranial atherosclerotic stenosis. Neurological research 2005; 27 (Suppl. 01) S84-8.
    CrossrefPubMedGoogle Scholar
  • 23 Qureshi AI. et al. Early and intermediate-term outcomes with drug-eluting stents in high-risk patients with symptomatic intracranial stenosis. Neurosurgery 2006; 59 (05) 1044-51.
    CrossrefPubMedGoogle Scholar
  • 24 Zaidat OO. et al. The NIH registry on use of the Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology 2008; 70 (17) 1518-24.
    CrossrefPubMedGoogle Scholar
  • 25 Chimowitz MI. et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. The New England journal of medicine 2011; 365 (11) 993-1003.
    CrossrefPubMedGoogle Scholar
  • 26 Bose A. et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 2007; 38 (05) 1531-7.
    CrossrefPubMedGoogle Scholar
  • 27 Leitlinien für Diagnostik und Therapie in der Neurologie; 4. überarbeitete Auflage. Stuttgart: Thieme Verlag; 2008. 654 ff.
    Google Scholar
  • 28 Association DwtscotEHR, Surgery EbtEAfC-T, Members ATF et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European heart journal 2010; 31 (19) 2369-429.
    CrossrefPubMedGoogle Scholar
  • 29 Wessels T. et al. Identification of embolic stroke patterns by diffusion-weighted MRI in clinically defined lacunar stroke syndromes. Stroke 2005; 36 (04) 757-61.
    CrossrefPubMedGoogle Scholar
  • 30 Glotzer TV. et al. The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circulation 2009; 02 (05) 474-80.
    Google Scholar
  • 31 Glotzer TV. et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation 2003; 107 (12) 1614-9.
    CrossrefPubMedGoogle Scholar
  • 32 Healey JS. et al. Subclinical atrial fibrillation and the risk of stroke. The New England journal of medicine 2012; 366 (02) 120-9.
    CrossrefPubMedGoogle Scholar
  • 33 Wachter R, Stahrenberg R, Groschel K. Subclinical atrial fibrillation: how hard should we look?. Heart 2013; 99 (03) 151-3.
    CrossrefPubMedGoogle Scholar
  • 34 Stahrenberg R. et al. Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm. Stroke 2010; 41 (12) 2884-8.
    CrossrefPubMedGoogle Scholar
  • 35 Kallmunzer B. et al. A structured reading algorithm improves telemetric detection of atrial fibrillation after acute ischemic stroke. Stroke 2012; 43 (04) 994-9.
    CrossrefPubMedGoogle Scholar
  • 36 Sinha AM. et al. Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): design and rationale. American heart journal 2010; 160 (01) 36-41 e1.
    CrossrefPubMedGoogle Scholar
  • 37 Gage BF. et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285 (22) 2864-70.
    CrossrefPubMedGoogle Scholar
  • 38 Lip GY. et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137 (02) 263-72.
    CrossrefPubMedGoogle Scholar
  • 39 Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. Journal of the American College of Cardiology 2011; 57 (02) 173-80.
    PubMedGoogle Scholar
  • 40 Pisters R. et al. A novel user-friendly score (HASBLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010; 138 (05) 1093-100.
    CrossrefPubMedGoogle Scholar
  • 41 Friberg L, Rosenqvist M, Lip GY. Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study. Circulation 2012; 125 (19) 2298-307.
    CrossrefPubMedGoogle Scholar
  • 42 Mant J. et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007; 370 (9586): 493-503.
    CrossrefPubMedGoogle Scholar
  • 43 Diener HC. Leitlinien für Diagnostik und Therapie in der Neurologie. Herausgegeben von der Kommission “Leitlinien” der Deutschen Gesellschaft für Neurologie. Stuttgart: Thieme Verlag; 2012
    Google Scholar
  • 44 Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet 1993; 342 (8882): 1255-62.
    CrossrefPubMedGoogle Scholar
  • 45 Connolly S. et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006; 367 (9526): 1903-12.
    CrossrefPubMedGoogle Scholar
  • 46 Connolly SJ. et al. Apixaban in patients with atrial fibrillation. The New England journal of medicine 2011; 364 (09) 806-17.
    CrossrefPubMedGoogle Scholar
  • 47 Diener HC. et al. Apixaban versus aspirin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a predefined subgroup analysis from AVERROES, a randomised trial. Lancet neurology 2012; 11 (03) 225-31.
    CrossrefPubMedGoogle Scholar
  • 48 Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage: structure, function, and role in thromboembolism. Heart 1999; 82 (05) 547-54.
    CrossrefPubMedGoogle Scholar
  • 49 Leung DY, Black IW, Cranney GB, Hopkins AP, Walsh WF. Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation. Journal of the American College of Cardiology 1994; 24 (03) 755-62.
    CrossrefPubMedGoogle Scholar
  • 50 Wang Y, Di Biase L, Horton RP, Nguyen T, Morhanty P, Natale A. Left atrial appendage studied by computed tomography to help planning for appendage closure device placement. Journal of cardiovascular electrophysiology 2010; 21 (09) 973-82.
    CrossrefPubMedGoogle Scholar
  • 51 Di Biase L. et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. Journal of the American College of Cardiology 2012; 60 (06) 531-8.
    CrossrefPubMedGoogle Scholar
  • 52 Holmes DR. et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 2009; 374 (9689): 534-42.
    CrossrefPubMedGoogle Scholar
  • 53 Connolly SJ. et al. Dabigatran versus warfarin in patients with atrial fibrillation. The New England journal of medicine 2009; 361 (12) 1139-51.
    CrossrefPubMedGoogle Scholar
  • 54 Granger CB. et al. Apixaban versus warfarin in patients with atrial fibrillation. The New England journal of medicine 2011; 365 (11) 981-92.
    CrossrefPubMedGoogle Scholar
  • 55 Patel MR. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. The New England journal of medicine 2011; 365 (10) 883-91.
    CrossrefPubMedGoogle Scholar
  • 56 Diener HC. et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet neurology 2010; 09 (12) 1157-63.
    CrossrefPubMedGoogle Scholar
  • 57 Hankey GJ. et al. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet neurology 2012; 11 (04) 315-22.
    CrossrefPubMedGoogle Scholar
  • 58 Easton JD. et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of the ARISTOTLE trial. Lancet neurology 2012; 11 (06) 503-11.
    CrossrefPubMedGoogle Scholar
  • 59 Mantha S, Ansell J. An indirect comparison of dabigatran, rivaroxaban and apixaban for atrial fibrillation. Thrombosis and Haemostasis 2012; 108 (03) 476-84.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 60 Rasmussen LH. et al. Primary and secondary prevention with new oral anticoagulant drugs for stroke prevention in atrial fibrillation: indirect comparison analysis. BMJ 2012; 345: e7097.
    CrossrefPubMedGoogle Scholar