超急性缺血性中风护理--当前治疗和未来方向。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY
Bruce Cv Campbell
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引用次数: 0

摘要

自首次血栓切除试验取得成功以来的十年间,缺血性中风的超急性期疗法继续快速发展。有效的治疗方法仍局限于再灌注,但仍在继续研究几种细胞保护方法。目前已证实静脉注射纤维蛋白溶解剂对使用灌注成像筛选出的患者有长达 24 小时的益处,但其在无致残症状患者中的作用似乎非常有限。在最新试验的荟萃分析中,特奈替普酶优于阿替普酶,辅助溶栓药物也是一个正在积极研究的领域。血管内血栓切除术对发病后24小时内的各种前循环和后循环大血管闭塞均有益处,而较远端闭塞、轻度表现和>24小时窗口期则是正在进行的试验中需要测试的主要前沿领域。影像学参数可预测预后,但似乎不会改变血栓切除术与标准药物治疗的相对治疗效果。因此,决定对哪些患者不进行血栓切除术是一项关键的临床挑战,需要谨慎而迅速地整合临床、影像学和患者偏好等方面的考虑因素。加速提供这些高效疗法的护理系统将为最多的中风患者带来最大的益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hyperacute ischemic stroke care-Current treatment and future directions.

A decade on from the first positive thrombectomy trials, hyperacute therapies for ischemic stroke continue to rapidly advance. Effective treatments remain limited to reperfusion, although several cytoprotective approaches continue to be investigated. Intravenous fibrinolytics are now demonstrated to be beneficial up to 24 h in patients selected using perfusion imaging, but their role in patients with non-disabling symptoms appears very limited. Tenecteplase is superior to alteplase in meta-analysis of the latest trials, and adjuvant thrombolytics are an area of active investigation. Endovascular thrombectomy is beneficial in a wide range of anterior and posterior circulation large vessel occlusions up to 24 h after onset with the more distal occlusions, mild presentations, and >24 h window being the main frontiers to be tested in ongoing trials. Imaging parameters are prognostic but appear not to modify the relative treatment benefit of thrombectomy versus standard medical care. Therefore, deciding who not to treat with thrombectomy is a key clinical challenge that requires careful but rapid integration of clinical, imaging, and patient preference considerations. Systems of care to accelerate delivery of these highly effective therapies will maximize benefits for the greatest number of patients with stroke.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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