Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, Room 377, Providence, RI, 02903, USA.
Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Curr Neurol Neurosci Rep. 2017 Sep;17(9):69. doi: 10.1007/s11910-017-0776-4.
Trials demonstrating marked benefit of mechanical thrombectomy (MT) for acute stroke caused by large vessel occlusion (LVO) in the anterior circulation have been the most significant advance in acute ischemic stroke in the past 20 years. However, despite this marked advance, there are still many hurdles to improving access to thrombectomy worldwide. Additionally, despite these advances, a substantial portion of patients with LVO still are left disabled.
The major randomized trials focused on patients within 6 h from symptom onset, with occlusion of the ICA or proximal MCA, small amount of permanently damaged brain, and a moderate to large clinical deficit. We will explore the role of thrombectomy outside of these areas, but also explore larger issues as they pertain to re-organization of stroke systems of care to improve access to this remarkable therapy. Now that we have proven, without a shadow of doubt, that rapid revascularization with mechanical thrombectomy improves outcomes in LVO stroke, we must reorganize our systems of care to improve access and assess the role for MT outside of the patients who meet trial criteria.
过去 20 年来，在急性缺血性脑卒中领域，经证实机械取栓术（MT）对前循环大动脉闭塞（LVO）引起的急性脑卒中具有显著疗效，这是最重大的进展。然而，尽管有了这一显著进展，仍有许多障碍限制了 MT 在全球范围内的应用。此外，尽管取得了这些进展，仍有相当一部分 LVO 患者留有残疾。
主要的随机试验集中在症状发作后 6 小时内、颈内动脉或近端 MCA 闭塞、永久性脑损伤量小、中至重度临床缺损的患者。我们将探讨这些试验以外的取栓治疗作用，还将探讨与脑卒中治疗系统重新组织相关的更大问题，以提高对这种卓越治疗方法的可及性。既然我们已经毫无疑问地证明了，急性 LVO 脑卒中患者进行机械取栓快速血管再通可改善预后，那么我们必须重新组织我们的医疗体系，以提高其可及性，并评估 MT 在符合试验标准的患者之外的作用。
