Background
The Interdisciplinary Stroke Center Munich (ISZM) is an initiative of clinical departments involved in stroke care at Klinikum GroßhadernLMU. It was founded in 2006 as an interdisciplinary organizational unit.
Treatment options for stroke patients and patients with cerebrovascular disease have widened enormously. Among the most important developments over the past 15 years are:
- the introduction of stroke units,
- establishing systemic thrombolysis for ischemic strokes,
- new treatment methods in the field of interventional neuroradiology and radiosurgery.
Interdisciplinary approaches to stroke care are becoming increasingly common. For many syndromes today there are multiple alternative treatment strategies.
Determining the optimal treatment strategy in an individual patient depends on many aspects including the following: clinical symptoms, general status of health, age, individually attendant circumstances. Many elderly patients have comorbid cardiopulmonary disease, are on multiple medications (e. g., for a coronary stent) or await surgical intervention. Medications need to be considered, and interventions carefully coordinated. As the brain has a low tolerance for ischemia, timely and coordinated action is essential. All these factors are taken into consideration by close interactions between Neurologists, Cardiologists, Interventionalists, Neuroanaesthesists etc. and by the work program.
Continued developments are currently being made in endovascular intervention (new devices and technologies), radiosurgery and combining different treatment strategies. One such example is the initiation of i.v. thrombolysis at outside hospitals combined with transfer to a major stroke centre (drip and ship) and subsequent mechanical (intraarterial) recanalization if necessary (staged escalation therapy) - or “bridging” therapies with GPIIbIIIa antagonists. Another example is endovascular therapy in patients with severe life-threatening cerebral venous sinus thrombosis, treatment with intra-arterial nimodipine in catastrophic vasospasms and treatment of cerebral angioma by means of the Cyberknife.
Sustainable developments of innovative treatment strategies require quality controls and prospective studies. This is accounted for by the work program of the Interdisciplinary Stroke Center Munich (ISZM).
