Cassella Courtney R, Jagoda Andy
Mount Sinai Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1620, New York, NY 10128, USA.
Mount Sinai Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1620, New York, NY 10128, USA.
Emerg Med Clin North Am. 2017 Nov;35(4):911-930. doi: 10.1016/j.emc.2017.07.007.
Acute ischemic stroke carries the risk of morbidity and mortality. Since the advent of intravenous thrombolysis, there have been improvements in stroke care and functional outcomes. Studies of populations once excluded from thrombolysis have begun to elucidate candidates who might benefit and thus should be engaged in the process of shared decision-making. Imaging is evolving to better target the ischemic penumbra salvageable with prompt reperfusion. Availability and use of computed tomography angiography identifies large-vessel occlusions, and new-generation endovascular therapy devices are improving outcomes in these patients. With this progress in stroke treatment, risk stratification tools and shared decision-making are fundamental.
急性缺血性卒中存在发病和死亡风险。自静脉溶栓疗法问世以来,卒中护理及功能转归已有所改善。针对曾被排除在溶栓治疗之外人群的研究,已开始阐明可能受益的患者,因此应让他们参与共同决策过程。影像学正在不断发展,以便更好地针对可通过及时再灌注挽救的缺血半暗带。计算机断层血管造影术的应用和普及可识别大血管闭塞,新一代血管内治疗设备也在改善这些患者的治疗效果。随着卒中治疗取得这一进展,风险分层工具和共同决策至关重要。