Rabinstein Alejandro A
Continuum (Minneap Minn). 2017 Feb;23(1, Cerebrovascular Disease):62-81. doi: 10.1212/CON.0000000000000420.
This article provides an update on the state of the art of the emergency treatment of acute ischemic stroke with particular emphasis on the alternatives for reperfusion therapy.
The results of several randomized controlled trials consistently and conclusively demonstrating that previously functional patients with disabling strokes from a proximal intracranial artery occlusion benefit from prompt recanalization with mechanical thrombectomy using a retrievable stent have changed the landscape of acute stroke therapy. Mechanical thrombectomy within 6 hours of symptom onset should now be considered the preferred treatment for these patients along with IV thrombolysis with recombinant tissue plasminogen activator (rtPA) within the first 4.5 hours for all patients who do not have contraindications for systemic thrombolysis. Patients who are ineligible for IV rtPA can also benefit from mechanical thrombectomy. Collateral status and time to reperfusion are the main determinants of outcome.
Timely successful reperfusion is the most effective treatment for patients with acute ischemic stroke. Systems of care should be optimized to maximize the number of patients with acute ischemic stroke able to receive reperfusion therapy.
本文提供急性缺血性卒中紧急治疗的最新技术进展，特别强调再灌注治疗的替代方法。
多项随机对照试验的结果一致且确凿地表明，先前功能正常、因颅内近端动脉闭塞导致致残性卒中的患者，通过使用可回收支架进行机械取栓实现快速再通可从中获益，这改变了急性卒中治疗的格局。对于这些患者，症状发作6小时内的机械取栓现在应被视为首选治疗方法，对于所有无全身溶栓禁忌证的患者，应在发病4.5小时内联合静脉注射重组组织型纤溶酶原激活剂（rtPA）进行溶栓治疗。不符合静脉注射rtPA条件的患者也可从机械取栓中获益。侧支循环状态和再灌注时间是预后的主要决定因素。
及时成功的再灌注是急性缺血性卒中患者最有效的治疗方法。应优化医疗系统，以最大限度地增加能够接受再灌注治疗的急性缺血性卒中患者数量。
