Department of Neurology, Union Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue in Hankou, Wuhan, 430022, China.
J Neurol. 2019 Feb;266(2):283-288. doi: 10.1007/s00415-018-8933-5. Epub 2018 Jun 19.
Intravenous alteplase given in an appropriate time window has been recommended in guidelines and effects are on the decline over time. In general, the clinical decision is primarily based on whether ischemic stroke patients are sent to hospitals within the time window. However, some patients sent to the hospital over time limitations are eligible to receive intervention for recanalization due to good collateral circulation. In this dilemma, "tissue window" can be more reliable, which means using the penumbra as a major criterion for patient recruitment. Hence, we herein aim to address how could "tissue window" be a complementary approach when it does not conform to the time window's indication and affirming value of the later one. Some efforts obeying the time window are discussed first. In the later sections, we give the details of the definition of "tissue window", and then compare various neuroimaging techniques to determine the penumbra and summarize favorable patterns. Finally, we will focus on how the "tissue window" extends the therapeutic time window under specific circumstances.
静脉注射阿替普酶在适当的时间窗内已被推荐用于指南中，并且其效果随着时间的推移而下降。一般来说，临床决策主要基于缺血性脑卒中患者是否在时间窗内被送往医院。然而，一些超过时间限制但仍有良好侧支循环的患者有资格接受再通干预。在这种困境中，“组织窗”可能更可靠，这意味着将半影区作为患者招募的主要标准。因此，我们旨在探讨当“组织窗”不符合时间窗的适应证时，它如何成为一种补充方法，并肯定后者的价值。首先讨论了一些遵守时间窗的努力。在后面的部分中，我们给出了“组织窗”的定义的详细信息，然后比较了各种神经影像学技术来确定半影区，并总结了有利的模式。最后，我们将重点关注“组织窗”如何在特定情况下扩展治疗时间窗。
