Siegel Jason, Pizzi Michael A, Brent Peel J, Alejos David, Mbabuike Nnenne, Brown Benjamin L, Hodge David, David Freeman W
Department of Neurology, Mayo Clinic, 4500 San Pablo Road,, Jacksonville, FL, 32224, USA.
Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA.
Curr Cardiol Rep. 2017 Aug;19(8):67. doi: 10.1007/s11886-017-0881-7.
This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit.
New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations. More rapid automated CT perfusion and angiography may demonstrate a vascular penumbra for neuroendovascular intervention. Further, the greatest advance in acute stroke treatment since 2014 is the demonstration that neuroendovascular catheter-based thrombectomy with stent retrievers recanalizing intracranial large vessel occlusion (LVO) improves both recanalization and long-term outcomes in several trials. Hemorrhagic transformation and severe large infarct cerebral edema remain serious post-stroke challenges, with new guidelines describing who and when patients should get medical or surgical intervention. The adage "time is brain" directs the most evidence-based approach for rapid stroke diagnosis for tPA eligible and LVO recanalization using an orchestrated team approach. The neurocritical care unit is the appropriate location to optimize stroke outcomes for the most severely affected stroke patients.
本综述将重点介绍急性缺血性卒中诊断和治疗的最新进展，特别关注神经重症监护病房中卒中护理的新特点和建议。
新研究表明，使用移动卒中单元和远程卒中技术对卒中进行院前治疗可能会使静脉注射组织型纤溶酶原激活剂（tPA）的卒中治疗更早进行，并且最近的研究表明tPA可以在以前的禁忌情况下使用。更快的自动CT灌注和血管造影可能会显示出适合神经血管内介入治疗的半暗带。此外，自2014年以来急性卒中治疗的最大进展是在多项试验中证明，使用支架取栓器进行基于神经血管内导管的血栓切除术以再通颅内大血管闭塞（LVO）可改善再通情况和长期预后。出血性转化和严重的大面积梗死性脑水肿仍然是卒中后的严重挑战，新指南描述了哪些患者以及何时应接受药物或手术干预。“时间就是大脑”这句格言指导了一种基于最充分证据的方法，即通过精心组织的团队方法，对符合tPA治疗条件的患者进行快速卒中诊断并实现LVO再通。神经重症监护病房是为受影响最严重的卒中患者优化卒中预后的合适场所。
