Rangel-Castilla Leonardo, Rajah Gary B, Shakir Hakeem J, Davies Jason M, Snyder Kenneth V, Siddiqui Adnan H, Levy Elad I, Hopkins L Nelson
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA -
J Cardiovasc Surg (Torino). 2016 Dec;57(6):758-768. Epub 2016 Sep 21.
Acute ischemic stroke is a leading cause of death and disability in the United States, responsible for 1 of every 20 deaths. The efficacy of intravenous tissue plasminogen activator (tPA) alone for recanalization of large-vessel occlusion (LVO) is low. Several randomized trials have now established endovascular treatment of LVO as a standard of care. Endovascular techniques continue to evolve at a rapid pace. This review seeks to report recent advances in endovascular technology, discuss the correlation between speed of reperfusion and patient outcomes, and present mobile stroke care, shortcoming of the recent technology (such as clot fragmentation), and potential solutions to overcome these drawbacks, as well as anesthetic considerations and cost-effectiveness.
急性缺血性中风是美国死亡和残疾的主要原因之一，每20例死亡中就有1例与之相关。单纯静脉注射组织型纤溶酶原激活剂（tPA）用于大血管闭塞（LVO）再通的疗效较低。现在，多项随机试验已将LVO的血管内治疗确立为一种护理标准。血管内技术继续在快速发展。本综述旨在报告血管内技术的最新进展，讨论再灌注速度与患者预后之间的相关性，并介绍移动卒中治疗、近期技术的缺点（如血栓破碎）、克服这些缺点的潜在解决方案，以及麻醉方面的考虑和成本效益。
