Brekenfeld C, Gralla J, Zubler C, Schroth G
Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg.
Rofo. 2012 Jun;184(6):503-12. doi: 10.1055/s-0031-1299122. Epub 2012 Feb 1.
The therapy of acute ischemic stroke aims at fast recanalization of the occluded brain vessel. In contrast to intravenous thrombolysis (IVT), endovascular approaches yield higher recanalization rates especially in large vessel occlusions. Mechanical thrombectomy with the Merci Retriever received FDA approval in 2004 as an adjunct to IVT or in the case of failed recanalization after IVT. The time window for treatment is 8 h from stroke onset. However, the recanalization rate was 55 %, still leaving space for further improvement. In addition to the Merci Retriever, the Penumbra System received FDA approval in 2008. The newest endovascular approach comprising retrievable intracranial stents results in an increased recanalization rate exceeding 90 % and has markedly reduced the time to recanalization. On the other hand, the complication rate has not increased yet. These promising results suggest a combined therapy for acute ischemic stroke. In a first step IVT can be started independently of the size of the treating hospital and in a next step the patient is transferred to a neuroradiological center. If vessel occlusion persists, additional endovascular recanalization is performed (bridging concept). Patients who don't qualify for IVT are candidates for mechanical thrombectomy up to 8 h after stroke onset.
急性缺血性卒中的治疗旨在快速使闭塞的脑血管再通。与静脉溶栓（IVT）相比，血管内治疗方法能获得更高的再通率，尤其是在大血管闭塞的情况下。2004年，Merci取栓器机械取栓术作为IVT的辅助治疗手段或IVT后再通失败时的治疗方法获得了美国食品药品监督管理局（FDA）的批准。治疗的时间窗为卒中发作后8小时。然而，其再通率为55%，仍有进一步提高的空间。除了Merci取栓器，Penumbra系统于2008年获得了FDA的批准。最新的包括可回收颅内支架的血管内治疗方法使再通率提高到超过90%，并显著缩短了再通时间。另一方面，并发症发生率尚未增加。这些令人鼓舞的结果提示了急性缺血性卒中的联合治疗方案。第一步，无论治疗医院规模大小均可启动IVT，第二步，将患者转至神经放射中心。如果血管闭塞持续存在，则进行额外的血管内再通（桥接概念）。不符合IVT条件的患者在卒中发作后8小时内是机械取栓的候选对象。
