Yakhkind Aleksandra, McTaggart Ryan A, Jayaraman Mahesh V, Siket Matthew S, Silver Brian, Yaghi Shadi
Department of Neurology, The Warren Alpert Medical School of Brown University , Providence, RI , USA.
Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University , Providence, RI , USA.
Front Neurol. 2016 Jun 10;7:86. doi: 10.3389/fneur.2016.00086. eCollection 2016.
A majority of patients with ischemic stroke present with mild deficits for which aggressive management is not often pursued. Comprehensive work-up and appropriate intervention for minor strokes and transient ischemic attacks (TIAs) point toward better patient outcomes, lower costs, and fewer cases of disability. Imaging is a key modality to guide treatment and predict stroke recurrence. Patients with large vessel occlusions have been found to suffer worse outcomes and could benefit from intervention. Whether intravenous thrombolytic therapy decreases disability in minor stroke patients and whether acute endovascular intervention improves functional outcomes in patients with minor stroke and known large vessel occlusion remain controversial. Studies are ongoing to determine ideal antiplatelet therapy for stroke and TIA, while ongoing statin therapy, surgical management for patients with carotid stenosis, and anticoagulation for patients with atrial fibrillation have all been proven to decrease the rate of stroke recurrence and improve outcomes. This review summarizes the current evidence and discusses the standard of care for patients with minor stroke and TIA.
大多数缺血性中风患者表现为轻度功能缺损，通常不会进行积极治疗。对轻度中风和短暂性脑缺血发作（TIA）进行全面检查和适当干预，可改善患者预后、降低成本并减少残疾病例。影像学检查是指导治疗和预测中风复发的关键手段。已发现大血管闭塞患者的预后较差，可能从干预中获益。静脉溶栓治疗是否能降低轻度中风患者的残疾率，以及急性血管内介入治疗是否能改善轻度中风且已知存在大血管闭塞患者的功能预后，仍存在争议。目前正在进行研究以确定中风和TIA的理想抗血小板治疗方案，而持续的他汀类药物治疗、颈动脉狭窄患者的手术治疗以及心房颤动患者的抗凝治疗均已被证明可降低中风复发率并改善预后。本综述总结了当前证据，并讨论了轻度中风和TIA患者的护理标准。
