Nogueira R G, Schwamm L H, Hirsch J A
Endovascular Neurosurgery/Interventional Neuroradiology Section, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. 02114, USA.
AJNR Am J Neuroradiol. 2009 Apr;30(4):649-61. doi: 10.3174/ajnr.A1486. Epub 2009 Mar 11.
Despite years of research and pioneering clinical work, stroke remains a massive public health concern. Since 1996, we have lived in the era of US Food and Drug Administration-approved intravenous (i.v.) recombinant tissue plasminogen activator (rtPA). This treatment, despite its promise, continues to exhibit its limitations. Endovascular therapy has several theoretic advantages over i.v. rtPA, including site specificity, longer treatment windows, and higher recanalization rates. In this article, we will review the various pharmacologic strategies for acute stroke treatment, providing both a historic context and the state of the art. The drugs will be classified on the basis of their theoretic rationale for therapy. Next, we will review the various devices and strategies for mechanical revascularization with an aim toward comprehensiveness. These range from wire disruption of thrombus to preclinical trials for novel mechanical solutions. This first installment of this 2-part series will end with an analysis of retrograde reperfusion techniques.
尽管经过多年研究和开创性的临床工作，但中风仍然是一个重大的公共卫生问题。自1996年以来，我们一直生活在美国食品药品监督管理局批准静脉注射重组组织型纤溶酶原激活剂（rtPA）的时代。这种治疗方法尽管前景广阔，但仍存在局限性。血管内治疗相对于静脉注射rtPA具有几个理论上的优势，包括部位特异性、更长的治疗窗口和更高的再通率。在本文中，我们将回顾急性中风治疗的各种药物策略，既提供历史背景，也介绍最新进展。这些药物将根据其治疗的理论依据进行分类。接下来，我们将全面回顾各种机械再灌注的设备和策略。这些策略涵盖从血栓的钢丝破碎到新型机械解决方案的临床前试验。这个两部分系列文章的第一部分将以对逆行再灌注技术的分析作为结尾。
