急性缺血性卒中的血管内再灌注治疗：剖析证据
Endovascular reperfusion therapies for acute ischemic stroke: dissecting the evidence.
作者信息
Tsivgoulis Georgios, Safouris Apostolos, Krogias Christos, Arthur Adam S, Alexandrov Andrei V
机构信息
a Second Department of Neurology , Attikon University Hospital , Athens , Greece.
b School of Medicine , University of Athens , Athens , Greece.
出版信息
Expert Rev Neurother. 2016 May;16(5):527-34. doi: 10.1586/14737175.2016.1168297. Epub 2016 Apr 7.
BACKGROUND
Ischemic stroke is a major cause of death and disability and intravenous thrombolysis has been the only approved acute reperfusion therapy (RT) for many years.
METHODS
Seven randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of endovascular therapy in patients with acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) have been recently published.
RESULTS
These studies have changed the treatment paradigm by establishing mechanical thrombectomy (MT) as the most effective acute stroke therapy for improving functional outcome in anterior circulation ELVO with a NNT of 6.
CONCLUSIONS
The present review will critically evaluate the results of these RCTs and of the existing meta-analyses investigating the safety and efficacy of endovascular therapy for AIS. Points of debate such as acute stroke imaging, posterior circulation stroke and general anesthesia will be addressed. We will also discuss health policies aiming to increase the availability of endovascular treatment for stroke patients.
背景
缺血性中风是导致死亡和残疾的主要原因，多年来静脉溶栓一直是唯一被批准的急性再灌注治疗（RT）。
方法
最近发表了七项随机对照临床试验（RCT），评估血管内治疗对因急性大血管闭塞（ELVO）导致的急性缺血性中风（AIS）患者的安全性和有效性。
结果
这些研究通过将机械取栓术（MT）确立为改善前循环ELVO功能结局最有效的急性中风治疗方法，改变了治疗模式，其治疗所需人数（NNT）为6。
结论
本综述将严格评估这些RCT以及现有荟萃分析的结果，这些分析调查了血管内治疗对AIS的安全性和有效性。还将讨论急性中风成像、后循环中风和全身麻醉等争议点。我们还将讨论旨在增加中风患者血管内治疗可及性的卫生政策。
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