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Schlaganfallbehandlung 2011

Neue therapeutische Optionen

Stroke treatment in 2011

Update on new therapeutic options

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Zusammenfassung

In der Akutbehandlung und Prävention des Schlaganfalls stehen neue therapeutische Möglichkeiten zur Verfügung. Trotzdem bleibt der Schlaganfall ein wichtiger Mortalitätsgrund und die häufigste Ursache für eine erworbene andauernde Behinderung. Aktuell sind nur 4 Therapieoptionen des akuten Schlaganfallmanagements evidenzbasiert. Dies sind die Behandlung in einer Stroke Unit für alle Subtypen des Schlaganfalls, die intravenöse Thrombolyse und frühe Gabe von Acetylsalicylsäure bei ischämischem Schlaganfall und die chirurgische Dekompression bei malignen Infarkten. Durch den Einsatz dieses therapeutischen Spektrums kann ein schlechtes Outcome um rund 20% (absolute Risikoreduktion) reduziert werden. Alle Patienten mit akutem Schlaganfall sollten auf eine Stroke Unit aufgenommen werden. Daher müssen neue Stroke Units in unterversorgten Regionen gegründet werden. Wie bei Schlaganfallzentren und telemedizinischen Netzwerken nachgewiesen, können Thrombolysraten von rund 20% erreicht werden, wenn das Bewusstsein der Öffentlichkeit und das akute Schlaganfallmanagement optimiert werden.

Patienten mit Schlaganfall und transitorisch ischämischer Attacke haben ein hohes Risiko eines erneuten Schlaganfalls oder eines anderen vaskulären Ereignisses. Verschiedene medikamentöse Behandlungen sind hoch effektiv, jedoch muss die Ätiologie des Schlaganfalls bestimmt werden, bevor die beste mögliche Sekundärprävention festgelegt werden kann. Die Umsetzung evidenzbasierter Therapien in die klinische Praxis ist eine wichtige Herausforderung der aktuellen Gesundheitsversorgung.

Abstract

New therapeutic options in acute treatment and prevention of stroke have become available. Nevertheless, stroke remains a major cause of death and the most frequent reason for acquired long-lasting disability. Currently, only four evidence-based treatments are available in acute stroke management. They consist of stroke unit care for all subtypes of stroke, of intravenous thrombolysis and early aspirin in ischemic stroke, and of surgical decompression in malignant infarctions. Using this therapeutic spectrum, the poor outcome of stroke patients can be reduced by approximately 20% (absolute risk reduction). All patients with acute stoke should be admitted to stroke units; therefore, new stroke units need to be established in underserved areas. As shown in stroke centers and telestroke networks, thrombolysis rates of around 20% can be achieved by optimizing public awareness and acute stroke management.

Stroke and TIA patients are at high risk of suffering a recurrent stroke or other vascular event. Several pharmacological treatments are highly effective but determination of stroke etiology is needed before the best possible secondary prevention can be determined. The translation of evidence-based treatments into clinical practice is an important challenge for current health care planning.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin:

Vortrags- bzw. Beratungshonorare durch die Firmen Lundbeck, Bayer, Sanofi, Takeda, Boehringer Ingelheim und UCB-Pharma.

Das Centrum für Schlaganfallforschung Berlin wird über eine Förderung des Bundesministeriums für Bildung und Forschung (BMBF) finanziert. Das Stroke-Einsatz-Mobil-Projekt wird durch die Technologiestiftung Berlin finanziert.

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  1. Centrum für Schlaganfallforschung Berlin, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    H.J. Audebert

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Audebert, H. Schlaganfallbehandlung 2011. Notfall Rettungsmed 14, 413–424 (2011). https://doi.org/10.1007/s10049-011-1472-6

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