Meckel S, Taschner C, ElSheikh S, Maurer C J, Urbach H
Klinik für Neuroradiologie, Uniklinik Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
Nervenarzt. 2015 Oct;86(10):1226-35. doi: 10.1007/s00115-015-4270-4.
To determine the importance of mechanical thrombectomy (MT) in the treatment of ischemic stroke.
Analysis and comparison of randomized controlled trials (RCT) of MT versus i.v. thrombolysis (IVT) considering pathophysiological and logistic aspects.
The use of MT is more effective than IVT for internal carotid artery terminus (ICAT), M1 segment and tandem occlusions, i.e. proximal internal carotid artery (ICA) occlusion or stenosis, even in patients older than 75-80 years of age. Due to the small sample sizes this question cannot be answered for patients with M2 occlusions. It is still uncertain whether MT is needed in patients with a low National Institutes of Health stroke scale (NIHSS) score, whether IVT is needed before MT and what type of imaging should be performed. Approximately one third of eligible patients currently undergo MT in Germany. Results from RCTs with stent retrievers for patients with vertebrobasilar artery occlusions are lacking.
After becoming established as a first-line therapy for patients with ICAT, M1 segment and tandem occlusions, the effectiveness of MT with stent retrievers has to proven in patients with more distal occlusions, low NIHSS scores and even vertebrobasilar artery occlusions.
确定机械取栓术（MT）在缺血性卒中治疗中的重要性。
从病理生理和逻辑方面分析并比较MT与静脉溶栓（IVT）的随机对照试验（RCT）。
对于颈内动脉末端（ICAT）、M1段和串联闭塞，即颈内动脉（ICA）近端闭塞或狭窄，即使是75 - 80岁以上的患者，使用MT比IVT更有效。由于样本量小，对于M2段闭塞患者无法回答这个问题。对于美国国立卫生研究院卒中量表（NIHSS）评分低的患者是否需要MT、MT前是否需要IVT以及应进行何种类型的影像学检查仍不确定。目前在德国，约三分之一符合条件的患者接受MT治疗。缺乏针对椎基底动脉闭塞患者使用支架取栓器的RCT结果。
在成为ICAT、M1段和串联闭塞患者的一线治疗方法后，支架取栓器MT在更远端闭塞、NIHSS评分低甚至椎基底动脉闭塞患者中的有效性仍有待证实。
