Jivan Kalpesh, Ranchod Kaushik, Modi Girish
Division of Neurology, Department of Neurosciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Cardiovasc J Afr. 2013 Apr;24(3):86-92. doi: 10.5830/CVJA-2013-001.
Acute ischaemic stroke can be treated by clot busting and clot removal. Thrombolysis using intravenous recombinanttissue plasminogen activator (IV r-TPA) is the current gold standard for the treatment of acute ischaemic stroke (AIS). The main failure of this type of treatment is the short time interval from stroke onset within which it has to be used for any benefit. The evidence is that IV r-TPA has to be used within 4.5 hours. Other modalities of treatment are not as effective and need more scrutiny and examination. The available modalities are intra-arterial thrombolysis and clot-retrieval devices. Not unexpectedly, recanalisation treatments have flourished at a rapid rate. Although vessel recanalisation is vital to increasing the possibility of significant tissue reperfusion, clinical trials need to emphasise functional outcomes rather than reperfusion/recanalisation rates to adequately assess success of these devices/techniques. Our view is that until these treatments become proven in large-scale studies, a greater endeavour should be made in resource-limited settings to expand facilities to enable intravenous r-tPA treatment within the 4.5-hour period following onset of stroke. The resources required are small with the main costs being a CT scan of the brain and the cost of r-tPA. This can easily be done in any emergency facility in any part of the world. What is needed is public awareness, and campaigns of 'stroke attack' should be revisited, especially in the resource-limited context. This approach at present will halt to some extent the stroke pandemic that we are facing.
急性缺血性中风可以通过溶栓和取栓进行治疗。使用静脉注射重组组织型纤溶酶原激活剂（IV r-TPA）进行溶栓是目前治疗急性缺血性中风（AIS）的金标准。这类治疗的主要不足在于，必须在中风发作后的短时间内使用才能有任何益处。有证据表明，IV r-TPA必须在4.5小时内使用。其他治疗方式效果较差，需要更多的审查和检验。现有的治疗方式包括动脉内溶栓和取栓装置。不出所料，再灌注治疗迅速蓬勃发展。尽管血管再通对于增加显著组织再灌注的可能性至关重要，但临床试验需要强调功能结局而非再灌注/再通率，以便充分评估这些装置/技术的成功率。我们认为，在这些治疗方法在大规模研究中得到验证之前，在资源有限的环境中应做出更大努力，扩大设施，以便在中风发作后的4.5小时内进行静脉注射r-tPA治疗。所需资源很少，主要成本是脑部CT扫描和r-tPA的费用。这在世界任何地方的任何急诊设施中都很容易做到。需要的是公众意识，应该重新开展“中风急救”运动，特别是在资源有限的情况下。目前这种方法将在一定程度上遏制我们正在面临的中风大流行。
