Kallmünzer B, Köhrmann M
Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland.
Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
Med Klin Intensivmed Notfmed. 2017 Nov;112(8):674-678. doi: 10.1007/s00063-017-0341-6. Epub 2017 Sep 11.
The standard of care for patients with acute stroke of the anterior circulation and large vessel occlusion is the combined treatment with intravenous rt-PA (recombinant tissue-type plasminogen activator) and endovascular thrombectomy. The therapy is highly effective while reducing functional deficits and long-term disability. International guidelines recommend thrombectomy during the first 6 h after symptom onset, but new evidence supports its use in selected patients within a time window of up to 24 h. Eligible patients show a clinical core mismatch, i. e. severe neurologic deficits contrasting to a small core of cerebral infarction. Future research questions regard the treatment of vessel occlusion at the M2 segments as well as the best anesthetic management during the intervention. The infrastructure of stroke care especially in rural areas is based on the drip-and-ship paradigm that implies emergency treatment with the start of intravenous thrombolysis at the nearest hospital followed by transport to an interventional center in case of large vessel occlusion.
前循环急性卒中合并大血管闭塞患者的标准治疗方案是静脉注射重组组织型纤溶酶原激活剂（rt-PA）与血管内血栓切除术联合治疗。该疗法在减少功能缺陷和长期残疾方面非常有效。国际指南建议在症状出现后的最初6小时内进行血栓切除术，但新证据支持在长达24小时的时间窗内对选定患者使用该疗法。符合条件的患者表现为临床核心不匹配，即严重的神经功能缺损与小面积脑梗死核心区域形成对比。未来的研究问题包括M2段血管闭塞的治疗以及干预期间最佳的麻醉管理。卒中护理的基础设施，尤其是在农村地区，基于“滴注转运”模式，即意味着在最近的医院开始静脉溶栓进行紧急治疗，随后在发生大血管闭塞时转运至介入中心。
