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急性缺血性卒中的血管内治疗

Endovascular treatment of acute ischemic stroke.

作者信息

Singh Paramdeep, Kaur Rupinderjeet, Kaur Amarpreet

机构信息

Department of Radiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot (Punjab), India.

出版信息

J Neurosci Rural Pract. 2013 Jul;4(3):298-303. doi: 10.4103/0976-3147.118787.

Abstract

Early recanalization of the occluded artery leads to better clinical outcomes in patients with acute ischemic stroke (AIS) through protection of the time-sensitive penumbra. Intravenous administration of pharmacologic thrombolytic agents has been a standard treatment for AIS. To get better rates of recanalization, enhance the time window, and diminish the possibility of intracranial hemorrhage, endovascular thrombectomy was launched, with first authorization of the Merci clot retriever, a corkscrew-like apparatus, followed by approval of the Penumbra thromboaspiration system. Both devices lead to a high rate of recanalization. On the other hand, time to recanalization was on an average of 45 minutes, with most of the patients attaining only partial recanalization. More lately, retrievable stents have shown promise in decreasing the time to recanalization, and attaining a superior rate of complete clot resolution. The retrievable stent can be released within the clot to engage it within the struts of the stent, and afterwards it is taken back by pulling it under flow arrest. Neurointerventional techniques have a persistently ever-increasing and stimulating role in the management of AIS, as indicated by the advent of several important techniques. Stent retrievers have the capability to be ascertained as the most important approach to endovascular stroke treatment.

摘要

闭塞动脉的早期再通通过保护时间敏感的半暗带,可使急性缺血性卒中(AIS)患者获得更好的临床结局。静脉注射药物溶栓剂一直是AIS的标准治疗方法。为了提高再通率、延长时间窗并降低颅内出血的可能性,开展了血管内血栓切除术,首先批准了Merci取栓器(一种螺旋状装置),随后批准了Penumbra血栓抽吸系统。这两种装置都能实现较高的再通率。另一方面,再通时间平均为45分钟,大多数患者仅实现部分再通。最近,可回收支架在缩短再通时间和提高完全血栓溶解率方面显示出前景。可回收支架可在血栓内释放,将其卡在支架的支柱内,然后在血流停滞的情况下通过牵拉将其收回。如几项重要技术的出现所示,神经介入技术在AIS的治疗中一直发挥着越来越重要且令人振奋的作用。支架取栓器有能力被确定为血管内卒中治疗的最重要方法。

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