Worthmann Hans, Ernst Johanna, Grosse Gerrit M
Neurologische Klinik mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30623, Hannover, Deutschland.
Inn Med (Heidelb). 2023 Dec;64(12):1143-1153. doi: 10.1007/s00108-023-01622-x. Epub 2023 Nov 10.
Ischemic stroke is one of the leading causes of death worldwide and the most frequent cause of permanent disability in adulthood. The acute treatment of stroke is time-critical and, according to the time is brain principle, it is important to determine as soon as possible whether recanalization treatment that can save the penumbra is possible. Intravenous thrombolysis (IVT) and, if a large vessel occlusion is identified, endovascular treatment (EVT) possibly in combination with IVT, are recommended. Further treatment in a stroke unit is another important component of acute stroke treatment. The best secondary preventive treatment must already be initiated in the acute phase. The cause of stroke guides making decisions on the ideal secondary preventive strategy. The most important etiologies of stroke are cardiac embolism, atherosclerotic macroangiopathy and cerebral microangiopathy (small vessel disease). Less frequent causes are dissections of arteries supplying the brain or vasculitis. In up to 20-30% of all cases, however, no clear etiology can be determined despite intensive investigation of the cause. This means corresponding uncertainty in the optimal secondary prevention that consists in particular of an anticoagulant medication adapted to the etiology, treatment of cardiovascular risk factors and if necessary surgical or interventional desobliterative procedures. This article describes the diagnostic procedure and the evidence-based treatment of ischemic stroke.
缺血性中风是全球主要死因之一，也是成年人永久性残疾的最常见原因。中风的急性治疗对时间要求极为关键，根据“时间就是大脑”的原则，尽快确定是否有可能进行挽救半暗带的再通治疗非常重要。推荐进行静脉溶栓（IVT），如果发现大血管闭塞，则可能需要进行血管内治疗（EVT），也可能联合IVT。在卒中单元进行进一步治疗是急性中风治疗的另一个重要组成部分。最佳的二级预防治疗必须在急性期就开始。中风的病因指导着理想二级预防策略的决策。中风最重要的病因是心脏栓塞、动脉粥样硬化性大血管病变和脑微血管病变（小血管疾病）。较少见的病因是供应脑部的动脉夹层或血管炎。然而，在所有病例中，高达20%-30%的患者尽管对病因进行了深入调查，仍无法确定明确的病因。这意味着在最佳二级预防方面存在相应的不确定性，二级预防尤其包括根据病因调整的抗凝药物治疗、心血管危险因素的治疗以及必要时的手术或介入性血管再通手术。本文描述了缺血性中风的诊断程序和循证治疗。
