急性缺血性脑卒中患者的延迟再通：晚通胜于不通？
Delayed recanalization in acute ischemic stroke patients: Late is better than never?
机构信息
Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Physiology, School of Medicine, Loma Linda University, Loma Linda, USA.
出版信息
J Cereb Blood Flow Metab. 2019 Dec;39(12):2536-2538. doi: 10.1177/0271678X19881449. Epub 2019 Oct 8.
Abstract
Successful recanalization of the occluded vessel as early as possible has been widely accepted as the key principle of acute ischemic stroke (AIS) treatment. Unfortunately, for many years, the vast majority of AIS patients were prevented from receiving effective recanalization therapy because of a narrow therapeutic window. Recently, a series of inspiring clinical trials have indicated that more patients may benefit from delayed recanalization during an expanded therapeutic window, even up to 24 h after symptom onset. However, could potentially salvageable brain tissue (penumbra) in patients who do not receive medication within 24 h still possible to be saved?
摘要
尽早使闭塞血管再通已被广泛接受为急性缺血性脑卒中（AIS）治疗的关键原则。遗憾的是，多年来，由于治疗时间窗较窄，绝大多数 AIS 患者无法接受有效的再通治疗。最近一系列振奋人心的临床试验表明，在扩大的治疗时间窗内，即使在症状发作后 24 小时，更多的患者可能受益于延迟再通。然而，在 24 小时内未接受药物治疗的患者中，是否仍有可能挽救那些可能挽救的脑组织（半暗带）？
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2
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3
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