Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI.
Wayne State University, Detroit, MI.
Acad Emerg Med. 2019 Jul;26(7):744-751. doi: 10.1111/acem.13698. Epub 2019 Mar 4.
The window for acute ischemic stroke treatment was previously limited to 4.5 hours for intravenous tissue plasminogen activator and to 6 hours for thrombectomy. Recent studies using advanced imaging selection expand this window for select patients up to 24 hours from last known well. These studies directly affect emergency stroke management, including prehospital triage and emergency department (ED) management of suspected stroke patients. This narrative review summarizes the data expanding the treatment window for ischemic stroke to 24 hours and discusses these implications on stroke systems of care. It analyzes the implications on prehospital protocols to identify and transfer large-vessel occlusion stroke patients, on issues of distributive justice, and on ED management to provide advanced imaging and access to thrombectomy centers. The creation of high-performing systems of care to manage acute ischemic stroke patients requires academic emergency physician leadership attentive to the rapidly changing science of stroke care.
急性缺血性脑卒中的治疗时间窗此前限制在静脉注射组织型纤溶酶原激活物的 4.5 小时内和取栓治疗的 6 小时内。最近使用先进影像学选择的研究将这一治疗时间窗扩大到最后一次已知正常时间后的 24 小时，适用于特定患者。这些研究直接影响了急诊脑卒中管理，包括院前分诊和疑似脑卒中患者的急诊科管理。本综述性文章总结了将缺血性脑卒中的治疗时间窗扩大到 24 小时的相关数据，并讨论了这些数据对脑卒中护理系统的影响。它分析了对识别和转运大血管闭塞性脑卒中患者的院前方案、分配公平性问题以及提供先进影像学检查和到取栓中心的途径等方面的影响。建立管理急性缺血性脑卒中患者的高效护理系统需要有学术背景的急诊医师的领导，关注脑卒中治疗的快速变化的科学。
