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Konsensuspapier „Peri- und postinterventioneller Schlaganfall bei Herzkatheterprozeduren“

Consensus paper on peri-interventional and postinterventional stroke during cardiac catheter procedures

  • Konsensuspapiere
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Periinterventionelle Schlaganfälle sind eine der häufigsten schweren Komplikationen bei Katheterinterventionen und der Katheterablation bei Vorhofflimmern und Kammertachykardien mit einer großen Wahrscheinlichkeit persistierender neurologischer Defizite. Da viele dieser zerebrovaskulären Komplikationen auf dem Kathetertisch auftreten, bietet sich die Möglichkeit einer akuten Intervention mit dem Ziel der Gefäßrekanalisation. Eine sofortige zerebrale Bildgebung und ein interdisziplinäres Vorgehen ohne Zeitverzug sind für jedes Herzkatheterlabor zu fordern. Liegt ein Gefäßverschluss zugrunde, so ist eine intraarterielle Thrombolyse, ggf. mit einer mechanischen Thrombusextraktion, die erfolgversprechendste Therapie. Allerdings handelt es sich um eine individuelle Therapieentscheidung, die von der lokalen interdisziplinären Fachkompetenz abhängt. Das erhöhte Risiko einer intrazerebralen Blutung aufgrund der im Regelfall vorbestehenden antithrombotischen Therapie muss gegen das drohende neurologische Defizit abgewogen werden. Aufgrund der hohen Morbidität und der verschiedenen potenziellen Therapieoptionen besteht der dringende Bedarf für systematische klinische Studien.

Abstract

Stroke is a serious complication of percutaneous coronary intervention and atrial fibrillation ablation procedures and patients have a high likelihood of persistent neurological deficits. Although formal criteria speak against intravenous or intra-arterial thrombolysis due to pre-existing antithrombotic and anticoagulation therapy, the conditions for recanalizing therapy are optimal due to the occurrence of vessel occlusion in the catheter suite or the chest pain unit. Brain imaging and an interdisciplinary approach are mandatory. In cases of intracerebral vessel occlusion intra-arterial thrombolysis possibly in combination with mechanical clot fragmentation is the first choice therapy. The management of the patient is always an individual therapeutic decision based on stroke severity, the pre-treatment with antithrombotic and anticoagulation drugs, the availability of a neuro-interventionalist and the qualification of the local team.

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Authors
  1. J. Röther
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  2. U. Laufs
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  3. M. Böhm
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  4. S. Willems
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  5. B. Scheller
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  6. M. Borggrefe
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  7. H. Darius
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  8. M. Endres
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  9. U. Zeymer
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  10. H.-C. Diener
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  11. M. Grond
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  12. W. Hacke
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  13. M. Forsting
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  14. M. Schumacher
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  15. M. Hennerici
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Röther, J., Laufs, U., Böhm, M. et al. Konsensuspapier „Peri- und postinterventioneller Schlaganfall bei Herzkatheterprozeduren“. Kardiologe 3, 375–387 (2009). https://doi.org/10.1007/s12181-009-0214-1

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  • DOI: https://doi.org/10.1007/s12181-009-0214-1

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