Sacco Ralph L, Chong Ji Y, Prabhakaran Shyam, Elkind Mitchell S V
Department of Neurology, College of Physicians and Surgeons Columbia University, New York, NY, USA.
Lancet. 2007 Jan 27;369(9558):331-41. doi: 10.1016/S0140-6736(07)60155-X.
Treatments for acute ischaemic stroke continue to evolve. Experimental approaches to restore cerebral perfusion include techniques to augment recanalising therapies, including combination of antiplatelet agents with intravenous thrombolysis, bridging therapy of combining intravenous with intra-arterial thrombolysis, and trials of new thrombolytic agents. Trials with MRI selection criteria are underway to expand the window of opportunity for thrombolysis. Sonothrombolysis and novel endovascular mechanical devices to retrieve or dissolve acute cerebral occlusions are being tested. Approaches to improve cerebral perfusion with other devices and induced hypertension are also being considered. Although numerous neuroprotective agents have not shown benefit, trials of hypothermia, magnesium, caffeinol, high doses of statins, and albumin are continuing. The findings of these randomised trials are anticipated to allow improved treatment of patients with acute stroke.
急性缺血性中风的治疗方法不断发展。恢复脑灌注的实验方法包括增强再通治疗的技术，如抗血小板药物与静脉溶栓联合使用、静脉溶栓与动脉内溶栓联合的桥接治疗以及新型溶栓药物试验。正在进行基于MRI选择标准的试验以扩大溶栓的机会窗口。超声溶栓以及用于取出或溶解急性脑栓塞的新型血管内机械装置正在进行测试。利用其他装置和诱导性高血压改善脑灌注的方法也在被考虑。尽管众多神经保护剂尚未显示出益处，但低温、镁、咖啡醇、高剂量他汀类药物和白蛋白的试验仍在继续。预计这些随机试验的结果将改善急性中风患者的治疗。
