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Hamostaseologie 2003; 23(02): 45-53
DOI: 10.1055/s-0037-1619575
Research Articles
Schattauer GmbH

Rekanalisierende Behandlung des akuten Schlaganfalls

Recanalizing therapies in acute stroke
T. Neumann-Haefelin
1   Klinik für Neurologie (Direktor: Prof. Dr. med. H. Steinmetz), Klinikum der Johann-Wolfgang-von-Goethe-Universität, Frankfurt am Main
,
M. Sitzer
1   Klinik für Neurologie (Direktor: Prof. Dr. med. H. Steinmetz), Klinikum der Johann-Wolfgang-von-Goethe-Universität, Frankfurt am Main
,
H. Steinmetz
1   Klinik für Neurologie (Direktor: Prof. Dr. med. H. Steinmetz), Klinikum der Johann-Wolfgang-von-Goethe-Universität, Frankfurt am Main
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Publikationsverlauf

Publikationsdatum:
27. Dezember 2017 (online)

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Zusammenfassung

Die systemische Thrombolyse der akuten zerebralen Ischämie mit rt-PA im 3-Stunden-Zeitfenster entwickelte sich in den vergangenen Jahren zur Standardtherapie. Seit Ende 2002 besteht eine europaweite Zulassung für diese Indikation. Für das 3- bis 6-Stunden-Zeitfenster gibt es bislang noch keine allgemein akzeptierte Behandlungsstrategie. Die Datenlage ist am günstigsten für die intraarterielle Thrombolyse, vorausgesetzt es liegt ein proximaler Verschluss der Arteria cerebri media vor. Eine systemische Thrombolyse jenseits der ersten 3 Stunden wird nicht generell empfohlen, aber in einzelnen Zentren bei ausgewählten Patienten durchgeführt. Neben Thrombolyseverfahren im engeren Sinne und neuen Ansätzen zur Optimierung thrombolytischer Therapie (z. B. Patientenauswahl mittels MRT) werden einzelne neuroradiologisch-interventionelle und chirurgische Rekanalisierungsmethoden diskutiert.

Summary

Systemic thrombolysis with rt-PA within 3 hours after symptom onset has developed into a standard therapy for acute stroke patients. Recombinant t-PA is now licensed in Europe for this indication. Within 3 to 6 hours, no general therapeutic standard has been established yet. Currently, the available data are in favor of intra-arterial thrombolysis for patients with proximal occlusions of the middle cerebral artery. Systemic thrombolysis is not generally recommended in this time window, but is used in some centers for selected patients. In addition to thrombolysis and new strategies to improve thrombolysis (including patient selection with MRI), several interventional and surgical recanalization techniques are discussed.

Schlüsselwörter

Schlaganfall - Thrombolyse - Rekanalisation

Keywords

Stroke - thrombolysis - recanalization
 

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