Hurford Robert, Sekhar Alakendu, Hughes Tom A T, Muir Keith W
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
Pract Neurol. 2020 Aug;20(4):304-316. doi: 10.1136/practneurol-2020-002557. Epub 2020 Jun 7.
Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.
急性缺血性中风是主要的公共卫生重点问题，对未来的神经科医生而言将变得愈发重要。有效的中风治疗的基石仍然是及时的再灌注治疗。这需要公众和急救人员尽早识别症状，分诊至合适的中风中心，并由主治中风团队进行高效评估和检查。治疗的目的是通过对适当选择的患者进行静脉溶栓和/或血管内血栓切除术，实现缺血半暗带的再通和再灌注。所有患者均应直接入住急性中风单元，以便密切监测早期神经功能恶化情况并预防继发性并发症。迅速查明中风机制可使患者开始适当的二级预防治疗。未来的目标包括提高血管内血栓切除术的可及性，利用先进成像技术延长治疗窗，以及研发神经保护剂以预防继发性神经元损伤。
