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Endovaskuläre Eingriffe in der interventionellen Neuroradiologie

Neue Aspekte

Endovascular interventions in neuroradiology

New aspects

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Zusammenfassung

Die interventionelle Neuroradiologie (INR) hat sich in den letzten 10 Jahren insbesondere in der Aneurysmabehandlung und in der akuten ischämischen Schlaganfallbehandlung etabliert, sodass die Zahl der Eingriffe, aber auch die Standorte mit spezieller neuroradiologischer Expertise zugenommen haben. Viele Eingriffe sind mittlerweile als Routine einzuordnen, sodass auch Routine und Prozessoptimierung für die interdisziplinäre Zusammenarbeit zwischen Neuroradiologie und Anästhesie Voraussetzung für Patientenschutz und einen reibungslosen Ablauf sind. Routine bedeutet hierbei, dass das Wissen um die Erkrankung und die Art der Behandlung sowie die gegenseitigen Anforderungen und Erwartungen von Interventionalist und Anästhesist bekannt sind. Zu differenzieren gilt der Notfalleingriff, bei dem die zeitlichen Abläufe kurz gehalten werden müssen, von dem elektiven Eingriff, der geplant unter optimierten Bedingungen ablaufen kann. Im vorliegenden Beitrag werden allgemeine Voraussetzungen hierfür benannt. Diskutiert werden die zwei häufigsten Interventionen: Behandlungen von Aneurysmen und Rekanalisationsbehandlungen beim akuten Schlaganfall.

Abstract

In the last 10 years interventional neuroradiology has become established especially in the endovascular treatment of aneurysms as the preferred treatment according to level 1 evidence and more recently in the treatment of acute ischemic stroke. These interventions are performed as routine procedures in an increasing number of centers. This, however, necessitates that anesthesiologists and neuroradiologists become increasingly more familiar with the complementary expectations and potential pitfalls in working together to maximise efficiency and patient safety. As a further challenge there are different aspects to be considered in elective procedures and emergency procedures where time is brain. This article highlights these aspects for the two most common procedures: aneurysm treatment and multimodal recanalization treatment for acute ischemic stroke.

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Abbreviations

ACI:

A. carotis interna

ACT:

„activated clotting time“

ASS:

Acetylsalicylsäure

AVF:

arteriovenöse Fistel

AVM:

arteriovenöse Malformation

BRAT:

Barrow Ruptered Aneurysm Trial

CARAT:

Cerebral Aneurysm Rerupture After Treatment

CT:

Computertomogramm

EKG:

Elektrokardiogramm

GREAT:

German Randomized Endovascular Aneurysm Trial

GP IIa/IIIb:

Glykoprotein IIb/IIIa

HELPS:

Hydrogel-coated Coils versus Bare Platinum Coils for the Endovascular Treatment of Intracranial Aneurysms

ICP:

„intracranial pressure“ (intrakranialer Druck)

IMS:

Interventional Management of Stroke

INR:

interventionelle Neuroradiologie

ISAT:

International Subarachnoid Aneurysm Trial

ISUIA:

International Study of Unruptured Intracranial Aneurysms

ITN:

Intubationsnarkose

IVT:

intravenöse Thrombolyse

LIF:

lokale intraarterielle Fibrinolyse

LMW:

„low molecular weight“

MAP:

„mean arterial pressure“ (mittlerer arterieller Druck)

MAPS:

Matrix and Platinum Science (Trial)

MR RESCUE:

Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy

mRS:

modified Rankin Score

NIHSS:

National Institutes of Health Stroke Scale

p.-a.:

posterior-anterior (Strahlengang)

PROACT:

Prolyse in Acute Cerebral Thromboembolism

PTA:

perkutane transluminale Angioplastie

PTT:

„partial thromboplastin time“ (partielle Thromboplastinzeit)

rt-PA:

„recombinant tissue-type plasminogen activator“

SAB:

Subarachnoidalblutung

SAMMPRIS:

Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis

SpO2 :

pulsoxymetrisch gemessene Sauerstoffsättigung

SWIFT:

Solitaire™ FR With the Intention For Thrombectomy

SYNTHESIS:

Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke

TREVO:

Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke

WASID:

Warfarin-Aspirin Symptomatic Intracranial Disease

ZVK:

zentraler Venenkatheter

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Danksagung

Herrn Prof. Dr med. Helmuth Forst, Chefarzt für Anästhesie und Intensivmedizin am Klinikum Augsburg, wird für seine stete Bereitschaft zur Diskussion, die bei der Abfassung des Manuskripts hilfreich war, gedankt.

Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Berlis gibt an, dass er zum Zeitpunkt der Abfassung des Manuskripts Beraterverträge mit den Firmen ev3/covidien und Microvention/Terumo besitzt. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Diagnostische Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstr. 2, 85156, Augsburg, Deutschland

    A. Berlis

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Berlis, A. Endovaskuläre Eingriffe in der interventionellen Neuroradiologie. Anaesthesist 62, 692–706 (2013). https://doi.org/10.1007/s00101-013-2227-1

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