Khatri Pooja
Continuum (Minneap Minn). 2014 Apr;20(2 Cerebrovascular Disease):283-95. doi: 10.1212/01.CON.0000446101.44302.47.
This review provides an overview of emergent evaluation of the stroke patient with an emphasis on practical issues regarding ischemic stroke treatment.
The IV recombinant tissue-type plasminogen activator (rtPA) treatment window has been expanded from 3 to 4.5 hours from symptom onset. The evidence for better outcomes with more rapid initiation of reperfusion therapies is very strong. Adjunctive endovascular therapy has not been shown to benefit all patients with moderate or severe strokes, and investigations are underway to identify subgroups that may benefit from this approach. Endovascular therapy should be considered for patients who are ineligible for IV rtPA and can begin treatment within 6 hours of stroke onset.
Effective emergent evaluation of a stroke patient requires well-organized systems that maximize speed of assessment and administration of appropriate therapies, including IV rtPA and endovascular therapies.
本综述概述了卒中患者的紧急评估，重点关注缺血性卒中治疗的实际问题。
静脉注射重组组织型纤溶酶原激活剂（rtPA）的治疗时间窗已从症状发作后的3小时延长至4.5小时。有非常充分的证据表明，更快速地启动再灌注治疗能带来更好的预后。辅助血管内治疗尚未被证明能使所有中重度卒中患者受益，目前正在进行相关研究以确定可能从这种治疗方法中获益的亚组患者。对于不符合静脉注射rtPA条件但能在卒中发作后6小时内开始治疗的患者，应考虑血管内治疗。
对卒中患者进行有效的紧急评估需要组织完善的系统，以最大限度地提高评估速度并给予适当治疗，包括静脉注射rtPA和血管内治疗。
