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Acute Stroke Therapy 1981–2009*

Therapie des akuten Schlaganfalls 1981–2009

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Abstract

This article includes a review of major intravenous and endovascular stroke trials, treatment options, and future aspects of acute stroke treatment in hemispheric and vertebrobasilar stroke. Since the invention of local intraarterial thrombolysis by Hermann Zeumer in 1981, acute stroke diagnostics and treatment have undergone dramatic improvement. This article addresses major topics in recent stroke treatment debates: optimization of patient selection, intravenous versus endovascular therapy, time window limitations, combined treatment with intravenous/intraarterial bridging therapies (intravenous/intraarterial recombinant tissue plasminogen activator [rtPA] bridging and intravenous glycoprotein IIb/IIIa inhibitor/intraarterial rtPA bridging) and modern endovascular treatment modes like percutaneous transluminal angioplasty (PTA)/stenting and mechanical thrombectomy devices. Modern acute stroke therapy networks should optimize their noninvasive diagnostic capacity to early identify candidates for endovascular therapy with rapid access to specialized neuroendovascular centers using standard protocols. The most promising approach in acute stroke treatment seems to be a combination of intravenous and endovascular revascularization procedure, combining early treatment initiation with direct clot manipulation and PTA/stenting in underlying stenosis with atherothrombotic occlusions. Further randomized studies comparing intravenous and endovascular treatment, mainly in the anterior circulation, have to be expected and need wide support of the neurologic and neuroradiologic stroke community.

Zusammenfassung

Seit Einführung der lokalen intraarteriellen Thrombolyse durch Hermann Zeumer 1981 haben sich die Diagnostik und die Behandlung des akuten Schlaganfalls dramatisch gebessert. Der Artikel umfasst die Ergebnisse der wichtigsten intravenösen und endovaskulären Schlaganfallstudien, Behandlungsoptionen und zukünftige Aspekte der akuten Schlaganfalltherapie in der vorderen und hinteren Zirkulation. Folgende Themen werden in der aktuellen Diskussion angesprochen: Optimierung der Patientenauswahl, intravenöse versus endovaskuläre Therapie, Betrachtungen zum Zeitfenster, die Kombination von intravenöser und intraarterieller „Bridging“-Therapie (intravenöses/intraarterielles rTPA-[rekombinanter Gewebe-Plasminogenaktivator-]Bridging und intravenöses-Glykoprotein IIb/IIIa mit intraarterielles rTPA-Bridging) und moderne endovaskuläre Methoden wie PTA/Stenting und mechanische Thrombektomiesysteme. Moderne Netzwerke für die akute Schlaganfallsbehandlung sollten ihre nichtinvasive CT/MR-Diagnostik optimieren, um Kandidaten für die endovaskuläre Behandlung möglichst früh zu erkennen und die Therapie mit assoziierten neurovaskulären Zentren schnellstmöglich einzuleiten. Zunehmende Bedeutung erlangen Kombinationstherapien mit intravenöser und endovaskulärer Therapie, um einen möglichst frühen Behandlungsbeginn mit direkter Thrombusmanipulation und ggf. PTA/Stenting bei zugrundeliegenden Stenosen zu gewährleisten. Randomisierte Studien von intravenöser und endovaskulärer Therapie sind insbesondere in der vorderen Zirkulation erforderlich und benötigen die breite Unterstützung der neurologischen und neuroradiologischen „stroke community“.

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  1. Department of Neurology, Asklepios Hospital Altona, Hamburg, Germany

    Bernd Eckert MD

  2. Department of Neuroradiology, Asklepios Hospital Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany

    Bernd Eckert MD

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* Dedicated to Professor Hermann Zeumer, MD, on the occasion of his 65th birthday and his retirement.

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Eckert, B. Acute Stroke Therapy 1981–2009*. Clin Neuroradiol 19, 8–19 (2009). https://doi.org/10.1007/s00062-009-8033-0

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