Stroke Center and Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
J Thromb Haemost. 2011 Jul;9 Suppl 1:333-43. doi: 10.1111/j.1538-7836.2011.04371.x.
The first generation of clinical reperfusion treatment, intravenous (IV) fibrinolysis with tissue plasminogen activator (tPA), was a transformative breakthrough in stroke care, but is far from ideal.
TO survey emerging strategies to increase the efficacy and safety of cerebral reperfusion therapy.
Narrative review.
Innovative IV pharmacologic reperfusion strategies include: extending IV tPA use to patients with mild deficits; developing novel fibrinolytic agents (tenecteplase, desmetolplase, plasmin); using ultrasound to enhance enzymatic fibrinolysis; combination clot lysis therapies (fibrinolytics with GPIIb/IIIa agents or direct thrombin inhibitors); co-administration of MMP-9 inhibitors to deter haemorrhagic transformation; and prehospital neuroprotection to support threatened tissues until reperfusion. Endovascular recanalisation strategies are rapidly evolving, and include intra-arterial fibrinolysis, mechanical clot retrieval, suction thrombectomy, and primary stenting. Combined approaches appear especially promising, using IV fibrinolysis to rapidly initiate reperfusion, mechanical endovascular treatment to debulk large, proximal thrombi, and intra-arterial (IA) fibrinolysis to clear residual distal thrombus elements and emboli.
第一代临床再灌注治疗，即静脉（IV）溶栓治疗联合组织型纤溶酶原激活剂（tPA），是卒中治疗中的一项变革性突破，但远非理想。
调查提高脑再灌注治疗疗效和安全性的新兴策略。
叙述性综述。
创新的 IV 药物溶栓策略包括：将 IV tPA 应用于轻度缺损的患者；开发新型溶栓药物（替奈普酶、去氨普酶、尿激酶）；应用超声增强酶性溶栓；联合血栓溶解治疗（溶栓联合 GPIIb/IIIa 药物或直接凝血酶抑制剂）；联合使用 MMP-9 抑制剂以防止出血转化；以及院前神经保护以支持受威胁的组织，直至再灌注。血管内再通策略正在迅速发展，包括动脉内溶栓、机械血栓切除术、抽吸血栓切除术和直接支架置入术。联合治疗方法似乎特别有前途，即使用 IV 溶栓快速启动再灌注，机械血管内治疗清除大的、近端血栓，以及动脉内（IA）溶栓清除残留的远端血栓和栓子。
