González R G
Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2696, USA.
AJNR Am J Neuroradiol. 2006 Apr;27(4):728-35.
The number of potential patients who are actually treated for acute ischemic stroke is disappointingly low, and effective treatments are making a minor impact on this major public health problem. Imaging is not regularly used to identify the ischemic penumbra, a key concept in stroke physiology, though it is capable of doing so in a clinically relevant manner. Evidence is accumulating that identification of the ischemic penumbra and making treatment decisions on the basis of its presence provide substantial benefit to patient outcomes. Moreover, the same studies suggest that an unexpectedly large proportion of patients are suitable for therapy well past the traditional time windows because of the existence of a substantial ischemic penumbra. Modern MR imaging and CT systems, now widely available, are capable of answering the most relevant physiologic questions in acute ischemic stroke. This capability presents new opportunities and responsibilities to neuroradiologists to make appropriate imaging readily available and to have the imaging data rapidly processed and interpreted. In this article, acute ischemic stroke therapy, including the role of imaging in current medical practice, is reviewed, and an evidence-based alternative to contemporary acute ischemic stroke therapy is suggested.
实际接受急性缺血性中风治疗的潜在患者数量低得令人失望，有效的治疗方法对这个重大的公共卫生问题影响甚微。尽管成像技术能够以临床相关的方式识别缺血半暗带（中风生理学中的一个关键概念），但它并未被常规用于此。越来越多的证据表明，识别缺血半暗带并基于其存在做出治疗决策能给患者的治疗结果带来显著益处。此外，同样的研究表明，由于存在大量的缺血半暗带，出乎意料的是，很大一部分患者在传统时间窗之后仍适合接受治疗。现在广泛应用的现代磁共振成像和计算机断层扫描系统能够回答急性缺血性中风中最相关的生理学问题。这种能力给神经放射科医生带来了新的机遇和责任，即提供易于获取的合适成像，并快速处理和解读成像数据。在本文中，我们回顾了急性缺血性中风治疗，包括成像在当前医疗实践中的作用，并提出了一种基于证据的当代急性缺血性中风治疗替代方案。
