Stroke
Dienstag, 04. Juli 2017CT- Stroke:
- Blutung oder andere Diagnose
- Frühzeichen eines Infarktes(Hyperdenses Arterienzeichen,Hypodenses oder verwaschene Hirngewebe Kontur)
- Infarktgroesse (ASPECTS)
- Mittels CT-Angiographie kann Indikation zur CT-Endovask. Therapie geprüft werden auch bei Antikoagulation.
ASPECTS: M1 - M3 inferior______________________________(3) M4 - M6 superior______________________________(3) Extrapyramidal_________________N. caud/ Linsenkern/Capsula int./ Insel_______(4) Score 10 normal, Score 0 am schlechtesten._______________________________Sum.(10)
CT-Endovask. Therapie: Innerhalb von 6 Std. (Leitlinien 2018: Bis zu 16-24 Std. nach Infarkt. Siehe unten (*))
- Kollateral Status + (CTA und 4D MIP) KM prox. u. dist. der Arterien Occlusion
- ASPECTS (8-10)
- Prox. intracran. Arterien Occlusion
CT-Perfusion Infarkt: MTT erhoet, CBV erniedrigt (CBV bei Tumor nicht erniedrigt)
MECHANISCHE_THROMBEKTOMIE_STROKE
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(*)What’s different from previous recommendations is that patients who are ineligible for intravenous (IV) tissue plasminogen activator (tPA) may now be selected for mechanical thrombectomy within 6 hours.
(*)This new recommendation is a level 1A. (28.01.2018)
In light of the new results from DEFUSE-3, and a second study called DAWN, published January 4 also in NEJM, the new guidelines recommend thrombectomy in eligible patients 6 to 16 hours after a stroke (another level 1A recommendation).
And on the basis of the DAWN results, the procedure is „reasonable“ in patients 16 to 24 hours after a stroke (level IIa-B-R).
IV alteplase or thrombolysis remains the cornerstone of stroke therapy,“ Dr Powers said at a media briefing. „Everyone who is eligible for this should get it, and it should not be delayed to determine if they’re eligible for another treatment.“ Innerhalb 4,5 Std. nach Stroke.
Mechanical thrombectomy and tPA „are not mutually exclusive,“ and patients can receive both interventions, he said.
Some patients who are not eligible for tPA — for example, those on blood thinners like warfarin — may still be eligible for mechanical thrombectomy, noted Dr Powers.
Conclusions—Swollen cerebral and cerebellar infarcts are critical conditions that warrant immediate, specialized
neurointensive care and often neurosurgical intervention. Decompressive craniectomy is a necessary option in many
patients. Selected patients may benefit greatly from such an approach, and although disabled, they may be functionally
independent. (Stroke. 2014;45:00-00.)
Stroke-2014-Wijdicks-01.str.0000441965.15164.d6
The Role of Imaging in Acute Ischemic Stroke
ischaemie_Lyse_mech._Thrombektomie
Bestimmung des frühen Zeitintervalls:
