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Akutes zerebrovaskuläres Ereignis – das kleine Einmaleins

Acute cerebrovascular events—fundamentals

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Zusammenfassung

Der akute ischämische Schlaganfall sowie eine Subarachnoidalblutung durch ein rupturiertes intrakranielles Aneurysma sind zwei unterschiedliche zerebrovaskuläre Notfälle, bei denen interventionell-neuroradiologische Therapieverfahren eine zentrale Rolle spielen. Fundierte Kenntnisse über die leitlinienbasierte Indikationsstellung und das jeweilige Vorgehen bei der endovaskulären Behandlung mit deren Vor- und Nachteilen sind Grundlage einer evidenzbasierten Therapieentscheidung. Dieser Artikel soll eine empirische Übersicht für alltägliche Praxissituationen bieten.

Abstract

Acute ischemic stroke and subarachnoid hemorrhage due to a ruptured intracranial aneurysm are cerebrovascular emergencies, in which interventional neuroradiological therapeutic procedures play a crucial role. Profound knowledge about indication based on current guidelines and treatment approaches with their advantages and disadvantages are the basis of an evidence-based therapeutic decision. This article aims to provide an empirical overview for everyday practical situations.

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Literatur

  1. Mahnken AH, Thomas C (2019) Interventionelle Radiologie:. Grundlagen vaskulärer Interventionen. Arter Rekanalisation Beim Schlaganfall 1:63–124, 268–293

    Google Scholar 

  2. NINDS-Group (The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group). (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  3. Nogueira RG, Lutsep HL, Gupta R, for the Trialists T. (2012) Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380:1231–1240

    Article  Google Scholar 

  4. Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38:967–973

    Article  Google Scholar 

  5. Broderick JP, Palesch YY, Demchuk AM, Interventional Management of Stroke IIII (2013) Endovascular therapy after intravenous t‑PA versus t‑PA alone for stroke. N Engl J Med 368:893–903

    Article  CAS  Google Scholar 

  6. Berkheimer OA, Fransen PS, Beumer D, Investigators MC (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20

    Article  Google Scholar 

  7. Goyal M, Demchuk AM, Menon BK, ETI (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372:1019–1030

    Article  CAS  Google Scholar 

  8. Fusaro M, Paola DL, Biondi-Zoccai G (2007) Pedal-plantar loop technique for a challenging below-the-knee chronic total occlusion: a novel approach to percutaneous revascularization in critical lower limb ischemia. J Invas Cardiol 19:E34–E37

    Google Scholar 

  9. Saver JL, Goyal M, Bonafe A, Investigators SP (2015) Stent-retriever thrombectomy after intravenous t‑PA vs. t‑PA alone in stroke. N Engl J Med 372:2285–2295

    Article  CAS  Google Scholar 

  10. Jovin TG, Chamorro A, Cobo E, Investigators RT (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2296–2306

    Article  CAS  Google Scholar 

  11. Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731

    Article  Google Scholar 

  12. Fischer U, Kaesmacher J, Strbian D et al (2022) Swift Direct Collaborators. Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet 400(10346):104–115. https://doi.org/10.1016/S0140-6736(22)00537-2

    Article  CAS  Google Scholar 

  13. Mokin M, Primiani CT, Siddiqui AH, Turk AS (2017) Aspects (Alberta stroke program early CT score) measurement using hounsfield unit values when selecting patients for stroke thrombectomy. Stroke 48:1574–1579. https://doi.org/10.1161/STROKEAHA.117.016745

    Article  Google Scholar 

  14. Powers WJ, Derdeyn CP, Biller J, American Heart Association Stroke C (2015) 2015 AHA/ASA focused update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:3020–3035

    Article  CAS  Google Scholar 

  15. Zaidat OO, Yoo AJ, Khatri P, Cerebral Angiographic Revascularization Grading C, group SRw, Force STiCIT (2013) Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44:2650–2663

    Article  Google Scholar 

  16. Ringleb PA, Veltkamp R Akutgherapie des ischämischen Schlaganfalls – Rekanalisierende Therapie (Update 2015). https://www.dsg-info.de/images/stories/DSG/PDF/Leitlinien/030140_LL_akuter-ischaemischer-schlaganfall_final.pdf. Zugegriffen: 1. Aug. 2022

  17. Wahlgren N, Moreira T, Michel P, ESO-KSU, ESO, ESMINT, ESNR, EAN (2016) Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska Stroke Update 2014/2015, sup-ported by ESO, ESMINT, ESNR and EAN. Int J Stroke 11:134–147

    Article  Google Scholar 

  18. Albers GW, Marks MP, Kemp S et al (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378(8):708–718

    Article  Google Scholar 

  19. Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct (DAWN). N Engl J Med 378(1):11–21

    Article  Google Scholar 

  20. Lansberg MG, Straka M, Kemp S et al (2012) MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11(10):860–867

    Article  Google Scholar 

  21. Lansberg MG, Christensen S, Kemp S et al (2017) Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke. Ann Neurol 81(6):849–856

    Article  Google Scholar 

  22. Albers GW, Marks MP, Kemp S, et al (2018) Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 378(8):708–718

    Article  Google Scholar 

  23. Anxionnat R, Tonnelet R, Derelle AL, Liao L, Barbier C, Bracard S (2015) Endovascular treatment of ruptured intracranial aneurysms: Indications, techniques and results. Diagn Interv Imaging 96(7–8):667–675

    Article  CAS  Google Scholar 

  24. Gruber A, Knosp E (2016) Therapie rupturierter zerebraler Aneurysmen: Behandlungsoptionen und derzeitige Studienlage. J Neurol Neurochir Psychiatr 17(3):90–100

    Google Scholar 

  25. Molyneux AJ, Kerr R, Stratton I et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neuro-surgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274

    Article  Google Scholar 

  26. Molyneux AJ, Kerr RS, Yu LM et al (2005) International sub-arachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:783–785

    Article  Google Scholar 

  27. Molyneux AJ, Kerr RS, Birks J et al (2009) Risk of recurrent sub-arachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long term follow-up. Lancet Neurol 8:427–433

    Article  Google Scholar 

  28. McDougall CG, Spetzler RF, Zabramski JM et al (2012) The barrow ruptured aneurysm trial. J Neurosurg 116:135–144

    Article  Google Scholar 

  29. Spetzler RF, McDougall CG, Albuquerque FC et al (2013) The barrow ruptured aneurysm trial: 3‑year results. J Neurosurg 119:146–157

    Article  Google Scholar 

  30. Bakker NA, Metzemaekers JDM, Groen RJM et al (2010) International Subarachnoid Aneurysm Trial 2009: endovascular coiling of ruptured intracranial aneurysms has no significant advantage over neurosurgical clipping. Neurosurgery 66:961–962

    Article  Google Scholar 

  31. Raper DMS, Allan R (2010) International Subarachnoid Trial in the long run: critical evaluation of the long term follow up data from the ISAT trial of clipping vs. coiling for ruptured intracranial aneurysms. Neurosurgery 66:1166–1169

    Article  Google Scholar 

  32. Ospel JM, Brouwer P, Dorn F et al (2020) Antiplatelet management for stent-assisted coiling and flow diversion of ruptured Intracranial aneurysms: a DELPHI consensus statement. AJNR Am J Neuroradiol 41(10):1856–1862

    Article  CAS  Google Scholar 

  33. Hutschenreuter B (2020): Endovaskuläre Therapie des Basilariskopfaneurysmas. Dissertation, LMU München, S 10–15

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Correspondence to Igor Dakovic.

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Interessenkonflikt

I. Dakovic, J. Göttler und A. Mpotsaris geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dakovic, I., Göttler, J. & Mpotsaris, A. Akutes zerebrovaskuläres Ereignis – das kleine Einmaleins. Radiologie 63, 24–29 (2023). https://doi.org/10.1007/s00117-022-01084-6

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  • DOI: https://doi.org/10.1007/s00117-022-01084-6

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