Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Germany.
Lancet Neurol. 2013 Jun;12(6):572-84. doi: 10.1016/S1474-4422(13)70091-7.
Early recanalisation and an increase in collateral blood supply are predictors of favourable outcome in acute ischaemic stroke. Since individual responses to intravenous treatment with alteplase are heterogeneous, additional intra-arterial thrombolytic and mechanical endovascular treatment is increasingly given. Despite encouraging findings from single-centre studies, data from randomised clinical trials have not proven the hypothesis that interventional recanalisation leads to a better outcome. Advanced thrombectomy devices, the effect of ultrasound-enhanced thrombolysis, and imaging-guided selection of patients outside the currently approved time-window are all under investigation. Although neuroprotective agents have not shown benefit in clinical trials, non-pharmacological treatment strategies-such as decompressive surgery, therapeutic hypothermia, transcranial laser treatment, or augmentation of cerebral collateral perfusion by different means (eg, partial aortic occlusion or sphenopalatine ganglion stimulation)-are topics of current research. The future of acute stroke therapy relies on evidence for individually tailored, effective, safe, and rapidly accessible treatment probably consisting of combined pharmacological and improved non-pharmacological approaches.
早期再通和侧支血液供应的增加是急性缺血性脑卒中预后良好的预测因素。由于个体对静脉内使用阿替普酶的反应存在异质性，因此越来越多地给予额外的动脉内溶栓和机械血管内治疗。尽管单中心研究的结果令人鼓舞，但来自随机临床试验的数据并未证明介入再通导致更好结果的假设。先进的血栓切除术装置、超声增强溶栓的效果以及在目前批准的时间窗之外对患者进行影像学引导选择，都在研究之中。尽管神经保护剂在临床试验中没有显示出益处，但非药物治疗策略——如减压手术、治疗性低温、经颅激光治疗，或通过不同方式增加脑侧支灌注（例如部分主动脉闭塞或蝶腭神经节刺激）——是当前研究的主题。急性脑卒中治疗的未来依赖于针对个体的、有效的、安全的和快速可获得的治疗的证据，可能包括联合药物和改进的非药物方法。
