Das virtuelle internationale Schlaganfallstudien-Archiv (VISTA) – Bedeutung für die Schlaganfallforschung

 

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Zusammenfassung

In den letzten 15 Jahren wurden viele kontrollierte Studien zur Behandlung des akuten Schlaganfalls durchgeführt. Das virtuelle internationale Schlaganfallstudienarchiv (VISTA) ist eine von der Industrie unabhängige Datenbank die prospektiv erhobene Daten aus vielen Therapiestudien für wissenschaftliche Analysen vorhält. Analysen der Datenbank zeigen eine schlechtere Prognose für Schlaganfallpatienten mit sehr hohen Blutdruckwerten bei der Aufnahme auf die Stroke Unit. Eine hämorrhagische Transformation eines ischämischen Insultes wird häufig bei kardioembolischen Insulten beobachtet und hat eine bimodale Verteilung. Bei Patienten mit später Transformation ist auch die Prognose schlechter. Bei bis zu 7 % aller Patienten mit frischer zerebraler Ischämie wird erstmals eine absolute Arrhythmie diagnostiziert. Es gibt in der Zwischenzeit gute Prognosemodelle, mit deren Hilfe sich die Langzeitprognose von zerebralen Ischämien und Blutungen vorhersagen lässt. Bei Blutungen hängt die Prognose vom initialen Wachstum der Blutung ab. Leider zeigt sich, dass die Prognose von Patienten die in Deutschland einen Schlaganfall erleiden, nicht besonders gut ist.

Abstract

In the last 15 years many studies have been performed on the treatment of acute stroke. The Virtual International Stroke Trials Archive (VISTA) is an investigator-initiated data base that contains prospectively collected data from patients with acute stroke recruited from controlled trials and is used to answer scientific questions. Analyses have shown that patients with very high blood pressure at the time of admission to a stroke unit have a poor prognosis. Haemorrhagic transformation of an ischaemic infarct is seen frequently in patients with cardio-embolic strokes. Haemorrhagic transformation follows a bimodal distribution with a poor prognosis when occurring late after stroke. In up to 7 % of patients with acute stroke, new onset atrial fibrillation is detected in the stroke unit. VISTA has enabled the establishment and validation of prognostic models for patients with ischaemic or haemorrhagic stroke. The most important risk factor for a poor prognosis in patients with cerebral bleeding is the growth of the initial haemorrhage. On a world-wide comparison, the prognosis of stroke patients in Germany is poorer than in many other countries.

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Prof. Dr. med. H. C. Diener

Direktor der Klinik und Poliklinik für Neurologie, Universitätsklinikum Essen

Hufelandstr. 55

45147 Essen

Email: hans.diener@uni-duisburg-essen.de