Neurointerventional Radiology, New York Presbyterian Hospital, College of Physicians & Surgeons, Columbia University, NY, USA.
Expert Rev Neurother. 2011 Aug;11(8):1125-39. doi: 10.1586/ern.11.102.
Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the established treatment for acute ischemic stroke patients presenting within 4.5 h of stroke onset based on the results of the National Institute of Neurological Disorders and Stroke Study Group trial and European Cooperative Acute Stroke Study III. In a significant number of patients, however, intravenous thrombolysis with rt-PA remains ineffective, with lower rates of recanalization, especially for proximal occlusions and a large thrombus burden. Newer thrombolytic agents, such as reteplase, tenecteplase or desmoteplase, offer pharmacokinetic and hemodynamic advantages over rt-PA and have been, or are currently being, tested for safety and efficacy in clinical trials. Agents such as direct fibrinolytics that do not depend on the availability of plasminogen are also being studied in ongoing trials. Endovascular revascularization is an evolving treatment option enabling mechanical clot disruption or extraction in combination with local directed pharmacological thrombolysis. Several new endovascular devices have been successfully tested for safety in acute ischemic stroke patients and are now being tested for efficacy in larger clinical trials. Continued innovation and refinement of endovascular technology and techniques, including combination therapy such as bridging therapy and the use of stent-like devices, is expected to increase technical success and improve overall efficacy and time to recanalization with minimal procedure-related morbidity in the treatment of acute ischemic stroke.
静脉注射重组组织型纤溶酶原激活剂（rt-PA）是目前治疗急性缺血性脑卒中患者的标准方法，适用于发病 4.5 小时以内的患者，该方法的疗效基于美国国立神经病学、语言障碍和卒中研究所临床试验组和欧洲合作急性卒中研究 III 的结果。然而，在相当数量的患者中，静脉注射 rt-PA 仍然无效，再通率较低，尤其是对于近端闭塞和大血栓负荷的患者。新型溶栓药物，如瑞替普酶、替奈普酶或地西溶栓酶，在药代动力学和血液动力学方面优于 rt-PA，并已在临床试验中或正在进行安全性和疗效的测试。在正在进行的试验中，也在研究不依赖纤溶酶原的直接溶栓剂等药物。血管内再通是一种不断发展的治疗选择，可结合局部定向溶栓进行机械性血栓破坏或提取。几种新型血管内设备已成功在急性缺血性脑卒中患者中进行了安全性测试，目前正在更大规模的临床试验中测试其疗效。预计血管内技术和技术的持续创新和改进，包括桥接治疗等联合治疗以及使用支架样装置，将提高技术成功率，并改善整体疗效和再通时间，同时最大限度地降低与治疗相关的发病率。
