Comprehensive Stroke Center, Neurovascular Ultrasound Laboratory, University of Alabama Hospital, Birmingham, AL, USA.
J Intern Med. 2010 Feb;267(2):209-19. doi: 10.1111/j.1365-2796.2009.02206.x.
In a quest for stroke treatment, reperfusion proved to be the first key to the puzzle. Systemic tissue plasminogen activator (tPA), the first and currently the only approved treatment, is also the fastest way to initiate thrombolyis for acute ischemic stroke. tPA works by induction of mostly partial recanalization since stroke patients often have large thrombus burden. Thus, early augmentation of fibrinolysis and multi-modal approach to improve recanalization are desirable. This review focuses on the following strategies available to clinicians now or being tested in clinical trials: (a) faster initiation of tPA infusion; (b) sonothrombolysis; (c) intra-arterial revascularization, bridging intravenous and intra-arterial thrombolysis, mechanical thrombectomy and aspiration; and (d) novel experimental approaches. Despite these technological advances, no single strategy was yet proven to be a 'silver bullet' solution to reverse acute ischemic stroke. Better outcomes are expected with faster treatment leading to early, at times just partial flow improvement rather than achieving complete recanalization with lengthy procedures. Arterial re-occlusion can occur with any of these approaches, and it remains a challenge since it leads to poor outcomes and no clinical trial data are available yet to determine safe strategies to prevent or reverse re-occlusion.
在寻找中风治疗方法的过程中，再灌注被证明是解开这个难题的关键。全身组织型纤溶酶原激活剂（tPA）是第一种也是目前唯一被批准的治疗方法，也是急性缺血性中风开始溶栓的最快方法。tPA 通过诱导部分再通起作用，因为中风患者通常有大量的血栓负担。因此，早期增强纤维蛋白溶解和多模式方法以改善再通是理想的。本综述重点介绍了目前可供临床医生使用或正在临床试验中测试的以下策略：（a）更快地开始 tPA 输注；（b）声溶栓；（c）动脉血管内再通，桥接静脉内和动脉内溶栓、机械血栓切除术和抽吸；以及（d）新型实验方法。尽管有了这些技术进步，但还没有一种单一的策略被证明是逆转急性缺血性中风的“灵丹妙药”。更快的治疗可以带来更好的结果，早期，有时只是部分血流改善，而不是通过冗长的程序实现完全再通。任何这些方法都可能导致动脉再闭塞，这仍然是一个挑战，因为它会导致不良结果，而且目前还没有临床试验数据来确定预防或逆转再闭塞的安全策略。
