Zhang Zhe, Pu Yuehua, Mi Donghua, Liu Liping
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2019 Jul 3;10:719. doi: 10.3389/fneur.2019.00719. eCollection 2019.
Cerebral recanalization therapy, either intravenous thrombolysis or mechanical thrombectomy, improves the outcomes in patients with acute ischemic stroke (AIS) by restoring the cerebral perfusion of the ischemic penumbra. Cerebral hemodynamic evaluation after recanalization therapy, can help identify patients with high risks of reperfusion-associated complications. Among the various hemodynamic modalities, magnetic resonance imaging (MRI), computed tomography perfusion, and transcranial Doppler sonography (TCD) are the most commonly used. Poststroke hypoperfusion is associated with infarct expansion, while hyperperfusion, which once was considered the hallmark of successful recanalization, is associated with hemorrhagic transformation. Either the hypo- or the hyperperfusion may result in poor clinical outcomes. Individual blood pressure target based on cerebral hemodynamic evaluation was crucial to improve the prognosis. This review summarizes literature on cerebral hemodynamic evaluation and management after recanalization therapy to guide clinical decision making.
脑再通治疗,无论是静脉溶栓还是机械取栓,都可通过恢复缺血半暗带的脑灌注来改善急性缺血性卒中(AIS)患者的预后。再通治疗后的脑血流动力学评估有助于识别有再灌注相关并发症高风险的患者。在各种血流动力学检查方法中,磁共振成像(MRI)、计算机断层扫描灌注成像和经颅多普勒超声(TCD)是最常用的。卒中后低灌注与梗死灶扩大有关,而曾被认为是成功再通标志的高灌注则与出血性转化有关。低灌注或高灌注都可能导致临床预后不良。基于脑血流动力学评估的个体化血压目标对于改善预后至关重要。本综述总结了再通治疗后脑血流动力学评估和管理的相关文献,以指导临床决策。