缺血性脑卒中的超早期血管再通方法

杨立刚; 管阳太

doi:10.12022/jnnr.2017-0020

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神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (2) : 61-65. DOI: 10.12022/jnnr.2017-0020

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缺血性脑卒中的超早期血管再通方法

杨立刚，管阳太

作者信息 +

Super-early vascular recanalization in ischemic stroke

YANG Ligang, GUAN Yangtai

Author information +

文章历史 +

摘要

随着缺血性脑卒中的日益高发和发病年龄的日趋年轻化，对超早期患者给予积极有效的血管再通治疗以恢复血流供应，对于脑卒中的治疗及后期功能康复均具有至关重要的意义。目前应用于临床的血管再通方法主要包括静脉溶栓、动脉溶栓、机械性再通和桥接治疗等。本文介绍了国际公认的缺血性脑卒中超早期临床血管再通方法，并针对缺血性脑卒中超早期血管再通方法应用中存在的一些争议热点进行讨论。

Abstract

With the increasing incidence of ischemic stroke and the younger age of onset, active and effective recanalization of blood vessels and recovery of blood supply are important in super-early treatment of stroke and the functional rehabilitation in the late stage. At present, the main methods of vascular recanalization are intravenous thrombolysis, arterial thrombolysis, mechanical recanalization and bridging therapy. This paper introduces the current internationally accepted super-early recanalization methods in ischemic stroke, and discusses some controversial points in the clinical practice.

导出引用

杨立刚，管阳太. 缺血性脑卒中的超早期血管再通方法[J]. 神经病学与神经康复学杂志. 2017, 13(2): 61-65 https://doi.org/10.12022/jnnr.2017-0020

YANG Ligang, GUAN Yangtai. Super-early vascular recanalization in ischemic stroke[J]. Journal of Neurology and Neurorehabilitation. 2017, 13(2): 61-65 https://doi.org/10.12022/jnnr.2017-0020

参考文献

[1] National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke[J]. N Engl J Med, 1995, 333(24):1581-1587.
[2] Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke[J]. N Engl J Med, 2008, 359(13):1317-1329.
[3] Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke[J]. N Engl J Med, 2012, 366(12):1099-1107.
[4] Tsivgoulis G, Sharma VK, Mikulik R, et al. Intravenous thrombolysis for acute ischemic stroke occurring during hospitalization for transient ischemic attack[J]. Int J Stroke, 2014, 9(4):413-418.
[5] Jeong SY, Park SS, Koh EJ, et al. Multimodal therapy for patients with acute ischemic stroke: outcomes and related prognostic factors[J]. J Korean Neurosurg Soc, 2009, 45(6):360-368.
[6] Mehrpour M, Aghaei M, Motamed MR. Safety and feasibility of intravenous thrombolytic therapy in Iranian patients with acute ischemic stroke[J]. Med J Islam Repub Iran, 2013, 27(3):113-118.
[7] Mathews MS, Sharma J, Snyder KV, et al. Safety, effectiveness, and practicality of endovascular therapy within the first 3 hours of acute ischemic stoke onset[J]. Neurosurgery, 2009, 65(5):860-865.
[8] Mori E, Minematsu K, Nakagawara J, et al. Factors predicting outcome in stroke patients treated with 0.6 mg/kg alteplase: evidence from the Japan Alteplase Clinical Trial (J-ACT)[J]. J Stroke Cerebrovasc Dis, 2011, 20(6):517-522.
[9] Adams H, Adams R, Del Zoppo G, et al. Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association[J]. Stroke, 2005, 36(4):916-923.
[10] Sliwka U, Mull M, Stelzer A, et al. Long-term follow-up of patients After intra arterial thrombolytic therapy of acut vertebrobasilar artery occlusion[J]. Cerebrovasc Dis, 2001, 12(3):214 -219.
[11] Cross DT 3rd, Moran CJ, Akins PT, et al. Relationship between clot location and outcome after basilar artery thrombolysis[J]. AJNR Am J Neuroradiol, 1997, 18(7):1221-1228.
[12] Nogueira RG, Lutsep HL, Gupta R, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial[J]. Lancet, 2012, 380(9849):1231-1240.
[13] Hann S, Chalouhi N, Starke R, et al. Comparison of neurologic and radiographic outcomes with Solitaire versus Merci/Penumbra systems for acute stroke intervention[J]. Biomed Res Int, 2013:715170. doi: 10.1155/2013/715170.
[14] Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intra arterial treatment for acute ischemic stroke[J]. N Engl J Med, 2015, 372(1):11-20.
[15] Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med, 2015, 372(11):1019-1030.
[16] Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med, 2015, 372(11):1009-1018.
[17] Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke[J]. N Engl J Med, 2015, 372(24):2285-2295.
[18] Wang H, Zi W, Hao Y, et al. Direct endovascular treatment: an alternative for bridging therapy in anterior circulation large-vessel occlusion stroke[J]. Eur J Neurol, 2017, 24(7):935-943.