Akuttherapie des Schlaganfalls

Abstract

This article covers three major topics of acute stroke therapy: extension of the time window for thrombolysis with desmoteplase, decompressive surgery after malignant middle cerebral artery infarction, and the effect of hemostatic therapy with recombinant activated factor VII (rFVIIa) in patients with spontaneous primary intracerebral hemorrhage. Thrombolytic therapy with recombinant tissue or tissue-type plasminogen activator is still the only approved acute stroke therapy within a 3-h time window. Imaging-based patient selection seems to help extending this time window. After promising results of two phase II trials with the thrombolytic agent desmoteplase in an extended time window after acute ischemic stroke, the DIAS-II study was reconducted in Europe, North America, and Australia as a phase III trial. First results of the included 186 patients are shown. Surprisingly, patients treated with desmoteplase had no better outcome than placebo-treated patients, and there was increased mortality in the high-dose group. Among all stroke subtypes, space-occupying malignant middle cerebral artery is one with the poorest prognosis. Most patients die within a few days due to the development of massive brain edema, despite maximum intensive care. Decompressive hemicraniectomy represents a much more effective therapy for the treatment of local brain swelling. However, until recently this method was highly controversial. Here we present the results of the randomized trials published in 2007 and discuss their relevance for acute therapy. Hematoma growth occurs within 4 h in one third of patients who suffer from intracerebral hemorrhage. Prospective, placebo-controlled, multicenter trials have shown that intravenous application of rFVIIa reduces volume increase. We present preliminary results of the latest phase III trial (FAST: recombinant factor VIIa in acute hemorrhagic stroke), which tried to find whether the hemostatic effect will translate into clinical effect.

Bats: A Glimpse on Their Astonishing Morphology and Lifestyle

“…And at last, it should be mentioned that the studies on the saliva of the vampire bat Desmodus rotundus led to a new and effective enzymatic therapy of aplexia by suspending blood clots (Schleunig 1993;Reddrop et al 2005;Steiner et al 2007).…”

Der Schlaganfall beim Diabetespatienten

“…Dies liegt neben der Einführung einer spezifischen Therapie (Thrombolyse) vor allem an der Einführung von "Stroke Units" mit der Möglichkeit der simultanen Diagnostik, Überwachung, Früh-therapie, Frührehabilitation und spezieller Pflege [26,33,59]. In der Akutphase des Schlaganfalls und vor allem während des Zeitfensters, in dem die Thrombolyse zugelassen ist, ist die hyperglykämische Stoffwechselsituation besonders kritisch.…”