Der Nervenarzt

, Volume 78, Issue 4, pp 393–405 | Cite as

Thrombolyse bei ischämischem Schlaganfall

Ein Update
  • M. Köhrmann
  • E. Jüttler
  • H.B. Huttner
  • P.D. Schellinger
Übersichten

Zusammenfassung

Auch 10 Jahre nach Zulassung der Thrombolyse wird diese lebensrettende und Behinderung reduzierende Therapie weiterhin viel zu selten angewendet. Hauptgründe dafür sind unter anderem das frühe und kurze Zeitfenster, die für Neurologen ungewöhnliche Aggressivität der Therapie und damit verbunden Zweifel an ihrer Effektivität und Sicherheit. Das Bewusstsein in der Bevölkerung zu verankern, dass ein Schlaganfall einen behandelbaren medizinischen Notfall darstellt, erfordert intensive und kontinuierliche Anstrengungen. Vor dem Hintergrund knapper werdender Ressourcen kommt neben medizinischen Gründen auch aus ökonomischen Überlegungen einer effektiven Schlaganfalltherapie ein hoher Stellenwert zu. Die Ergebnisse von weiteren aktuellen Studien wie z. B. der großen europäischen Anwendungsstudie SITS-MOST stärken das Vertrauen in die Thrombolysetherapie des akuten Schlaganfalls. Dazu werden auch die Entwicklung und die Weiterentwicklung neuer bildgebender Verfahren, wie moderne MRT- oder erweiterte CT-Techniken beitragen, die eine sicherere und verbesserte Patientenselektion und möglicherweise eine Erweiterung des engen Zeitfensters ermöglichen. Die intraarterielle Thrombolyse gegebenenfalls in Kombination mit intravenöser Lyse im sog. „Bridging-Verfahren“ oder unter Einsatz neuer intravasaler mechanischer Kathetervarianten ist Gegenstand intensiver Forschung. Auch wenn bisher keine randomisierten Studien zur Verfügung stehen, stellt die intraarterielle Thrombolyse für die Therapie des akuten Basilarisverschlusses weiterhin die Therapie der Wahl dar. Falls eine intraarterielle Therapie nicht verfügbar ist, ist die intravenöse Thrombolyse eine eventuell gleichwertige Option.

Schlüsselwörter

Thrombolyse Ischämischer Schlaganfall Zeitfenster Schlaganfalltherapie SITS-MOST Bridging-Verfahren 

Thrombolysis for ischemic stroke

An update

Summary

Even 10 years after the approval of thrombolysis this life-saving and disability reducing therapy is still underused. Important reasons for that are very strict inclusion criteria such as the early and narrow time-window, fear of bleeding complications and doubts regarding the effectivity. An intensive and constant effort is required to educate the public that stroke is a treatable emergency. In addition to the medical reasons, economic considerations in a context of decreasing resources emphasize the importance of effective stroke treatment. The results of numerous recent studies such as the European register SITS-MOST help to strengthen the confidence in thrombolysis. In addition the development and advancement of new imaging tools such as multiparametric MRI and advanced CT-techniques will improve patient selection and may enable us to extend the time-window for treatment. Intraarterial thrombolysis, „bridging” methods and new devices for intravascular intervention are the subjects of intensive ongoing research. Even though no randomized trials are available intraarterial thrombolysis is the treatment of choice for acute basilar occlusion, but if this intervention is not available an intravenous approach may be an equal alternative.

Keywords

Bridging technique Ischemic stroke SITS-MOST Stroke therapy Thrombolysis Time frame 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • M. Köhrmann
    • 1
  • E. Jüttler
    • 2
  • H.B. Huttner
    • 1
  • P.D. Schellinger
    • 1
  1. 1.Neurologische UniversitätsklinikErlangenDeutschland
  2. 2.Neurologische Universitätsklinik HeidelbergDeutschalnd

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