Schlaganfall: Zukunft

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[Bearbeiten] Literatur

[Bearbeiten] Sulfonylharnstoffe beim Schlaganfall

  • PMID - 17673715
  • TI - Sulfonylureas improve outcome in patients with type 2 diabetes and acute ischemic stroke.
    • AB - BACKGROUND AND PURPOSE: The sulfonylurea receptor 1-regulated NC(Ca-ATP) channel is upregulated in rodent models of stroke with block of the channel by the sulfonylurea, glibenclamide (glyburide), significantly reducing mortality, cerebral edema, and infarct volume. We hypothesized that patients with type 2 diabetes mellitus taking sulfonylurea agents both at the time of stroke and during hospitalization would have superior outcomes. METHODS: We reviewed medical records of patients with diabetes mellitus hospitalized within 24 hours of onset of acute ischemic stroke in the Neurology Clinic, Charite Hospital, Berlin, Germany, during 1994 to 2000. After exclusions, the cohort comprised 33 patients taking a sulfonylurea at admission through discharge (treatment group) and 28 patients not on a sulfonylurea (control group). The primary outcome was a decrease in National Institutes of Health Stroke Scale of 4 points or more from admission to discharge or a discharge National Institutes of Health Stroke Scale score of 0. The secondary outcome was a discharge modified Rankin Scale score < or =2.

[Bearbeiten] RESULTS:

No significant differences, other than stroke subtype, were observed among baseline variables between control and treatment groups. The primary outcome was reached by

  • 36.4% of patients in the treatment group and
  • 7.1% in the control group (P=0.007).

The secondary outcome was reached by

  • 81.8% versus
  • 57.1% (P=0.035).

Subgroup analyses showed that improvements occurred only in patients with nonlacunar strokes and were independent of gender, previous transient ischemic attack, and blood glucose levels. CONCLUSIONS: Sulfonylureas may be beneficial for patients with diabetes mellitus with acute ischemic stroke. Further investigation of similar cohorts and a prospective randomized trial are recommended to confirm the present observations. AD - Department of Neurology, Center for Stroke Research, Humboldt University, Berlin, Germany. FAU - Kunte, Hagen FAU - Schmidt, Sein AU - Schmidt S SO - Stroke. 2007 Sep;38(9):2526-30. Epub 2007 Aug 2.

[Bearbeiten] Verbesserung und Verbreiterung der Lyseindikation durch PerfusionsCTs

[Bearbeiten] Behandlung der Hirnblutung mit rekombiniertem Faktor7a

  • N Engl J Med. 2005 Feb 24;352(8):777-85.
    • Recombinant activated factor VII for acute intracerebral hemorrhage.
      • Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T; Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators.
      • Department of Neurology, Columbia University College of Physicians and Surgeons, New York, USA. sam14@columbia.edu

CONCLUSIONS: Treatment with rFVIIa within four hours after the onset of intracerebral hemorrhage limits the growth of the hematoma, reduces mortality, and improves functional outcomes at 90 days, despite a small increase in the frequency of thromboembolic adverse events.

[Bearbeiten] Verbesserung der Kollateralgefäßversorgung im Gehirn durch GM-CSF

  • Edda Schneeloch, Günter Mies, Hans-Jörg Busch, Ivo R. Buschmann, Konstantin-Alexander Hossmann

Granulocyte-macrophage colony-stimulating factor-induced arteriogenesis reduces energy failure in hemodynamic stroke PNAS, 101: 12730-35,. August 2004

[Bearbeiten] Verbesserung des Lyseergebnis mit Ultraschallanwendung auf den Thrombus

  • N Engl J Med. 2004 Nov 18;351(21):2170-8.
    • Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke.
    • Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, Montaner J, Saqqur M, Demchuk AM, Moye LA, Hill MD, Wojner AW; CLOTBUST Investigators.

In patients with acute ischemic stroke, continuous transcranial Doppler augments t-PA-induced arterial recanalization, with a nonsignificant trend toward an increased rate of recovery from stroke, as compared with placebo.

[Bearbeiten] Verbesserung der Rehabilitation mit

[Bearbeiten] Stenting der Carotiden

  • N Engl J Med. 2004 Oct 7;351(15):1493-501.
    • Protected carotid-artery stenting versus endarterectomy in high-risk patients.
    • Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators.

Among patients with severe carotid-artery stenosis and coexisting conditions, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy. Copyright 2004 Massachusetts Medical Society.

[Bearbeiten] Verminderung der Spastik mit Botulinustoxin

  • N Engl J Med. 2002 Aug 8;347(6):395-400.
    • Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke.
    • Brashear A, Gordon MF, Elovic E, Kassicieh VD, Marciniak C, Do M, Lee CH, Jenkins S, Turkel C; Botox Post-Stroke Spasticity Study Group.

Intramuscular injections of botulinum toxin A reduce spasticity of the wrist and finger muscles and associated disability in patients who have had a stroke.

[Bearbeiten] Citicoline (CiT) als Neuroprotektor

[Bearbeiten] Stent oder TEA bei Carotisstenose nach TIA ?

siehe http://idw-online.de/pages/de/news284340

  • Operation und Stent gleichermaßen erfolgreich bei der Schlaganfallvorbeugung.
  • Große Unterschiede bei den Komplikationsraten der einzelnen Therapiezentren.
  • EVA-3S-Studie: Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis
  • SAPPHIRE-Studie: The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy
  • SPACE-Studie: Stent-protected Percutaneous Angioplasty of the Carotid vs. Endarterectomy

[Bearbeiten] Literatur

Hitinder S. Gurm, Jay S. Yadav, Pierre Fayad, Barry T. Katzen, Gregory J. Mishkel, Tanvir K. Bajwa, Gary Ansel, Neil E. Strickman, Hong Wang, M.P.H., Sidney A. Cohen, Joseph M. Massaro, Donald E. Cutlip, for the SAPPHIRE Investigators: Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk Patients.

  • The New England Journal of Medicine, 2008; 358:1572-9

Hans-Henning Eckstein, Peter Ringleb, Jens-Rainer Allenberg, Jürgen Berger, Gustav Fraedrich, Werner Hacke, Michael Hennerici, Robert Stingele, Jens Fiehler, Hermann Zeumer and Olav Jansen: Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial.

  • The Lancet Neurology, 2008; 7: 893-902

Jean-Louis Mas, Ludovic Trinquart, Didier Leys, Jean-François Albucher, Hervé Rousseau, Alain Viguier, Jean-Pierre Bossavy, Béatrice Denis, Philippe Piquet, Pierre Garnier, Fausto Viader, Emmanuel Touzé, Pierre Julia, Maurice Giroud, Denis Krause, Hassan Hosseini, Jean-Pierre Becquemin, Grégoire Hinzelin, Emmanuel Houdart, Hilde Hénon, Jean-Philippe Neau, Serge Bracard, Yannick Onnient, Raymond Padovani and Gilles Chatellier for the EVA-3S investigators: Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial.

  • The Lancet Neurology, 2008; 7: 885-892

[Bearbeiten] Stammzellen nach Hirnblutung implantiert, Durchbruch bei der Schlaganfall Behandlung ?

siehe http://www.welt.de/welt_print/article2819100/Aerzten-gelingt-Durchbruch-bei-Schlaganfall-Behandlung.html

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