Laloux P
Department of Neurology, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
Acta Neurol Belg. 2001 Jun;101(2):88-95.
Early intravenous thrombolysis within the first three hours has been considered in the United States as the first proven treatment in acute ischemic stroke. However, not all patients will respond to this therapy which is also associated with a risk of symptomatic, including fatal, intracranial hemorrhage. This overview addresses the issue of efficacy and safety of intravenous alteplase (tPA) in acute cerebral ischemia. The rationale for thrombolytic therapy and its limits are described. The controlled studies show that intravenous tPA is effective and safe when given under restrictive conditions within 3 hours after stroke onset, but the data for a larger therapeutic window between 3 and 6 hours remain controversial. The expected functional improvement and the risk of intracranial hemorrhage greatly depend on selective clinical and imaging criteria. For this purpose, MRI, using the diffusion- and perfusion-weighted sequences combined with MR- angiography, should be preferred to CT scan in the next future. Applicability of tPA thrombolysis in current neurological practice in Belgium is discussed. Before its generalization, this therapy should be restricted to specialized stroke centers and all treated patients should be recorded in a central data bank to guarantee continued surveillance.
在美国，发病后三小时内尽早进行静脉溶栓已被视为急性缺血性卒中的首个经证实的治疗方法。然而，并非所有患者对该疗法都有反应，而且该疗法还存在包括致命性颅内出血在内的有症状出血风险。本综述探讨了静脉注射阿替普酶（tPA）治疗急性脑缺血的疗效和安全性问题。文中描述了溶栓治疗的基本原理及其局限性。对照研究表明，在卒中发作后3小时内，在严格条件下静脉注射tPA是有效且安全的，但关于3至6小时更大治疗窗的数据仍存在争议。预期的功能改善和颅内出血风险在很大程度上取决于选择性的临床和影像学标准。为此，在不久的将来，与磁共振血管造影相结合使用弥散加权序列和灌注加权序列的MRI应比CT扫描更受青睐。文中讨论了tPA溶栓在比利时当前神经科实践中的适用性。在推广该疗法之前，应将其限制在专门的卒中中心，并且所有接受治疗的患者都应记录在中央数据库中，以确保持续监测。
