Dorado Laura, Millán Mònica, Dávalos Antoni
Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain.
Curr Cardiol Rev. 2014 Nov;10(4):327-35. doi: 10.2174/1573403x10666140320144637.
Acute ischemic stroke is a major cause of morbidity and mortality in developed countries. Intravenous thrombolysis with tissue plasminogen activator (tPA) within 4.5 hours of symptoms onset significantly improves clinical outcomes in patients with acute ischemic stroke. This narrow window for treatment leads to a small proportion of eligible patients to be treated. Intravenous or intra-arterial trials, combined intravenous/intra-arterial trials, and newer devices to mechanically remove the clot from intracranial arteries have been investigated or are currently being explored to increase patient eligibility and to improve arterial recanalization and clinical outcome. New retrievable stent-based devices offer higher revascularization rates with shorter time to recanalization and are now generally preferred to first generation thrombectomy devices such as Merci Retriever or Penumbra System. These devices have been shown to be effective for opening up occluded vessels in the brain but its efficacy for improving outcomes in patients with acute stroke has not yet been demonstrated in a randomized clinical trial. We summarize the results of the major systemic thrombolytic trials and the latest trials employing different endovascular approaches to ischemic stroke.
急性缺血性中风是发达国家发病和死亡的主要原因。在症状出现4.5小时内静脉注射组织型纤溶酶原激活剂（tPA）可显著改善急性缺血性中风患者的临床预后。这一狭窄的治疗时间窗导致只有一小部分符合条件的患者能够接受治疗。为了增加患者的入选率、改善动脉再通情况和临床预后，人们已经对静脉或动脉内试验、静脉/动脉联合试验以及用于从颅内动脉机械清除血栓的新型装置进行了研究，或者目前正在探索中。新型可回收支架装置具有更高的再血管化率和更短的再通时间，现在通常比第一代取栓装置（如Merci Retriever或Penumbra System）更受青睐。这些装置已被证明对开通大脑中闭塞的血管有效，但在随机临床试验中尚未证明其对改善急性中风患者预后的疗效。我们总结了主要的全身溶栓试验结果以及采用不同血管内方法治疗缺血性中风的最新试验结果。
