JPK Stroke Research Center, Department of Neurology, Massachusetts General Hospital (MGH) and Harvard Medical School, Boston, MA, USA.
Department of Neurology, Eddy Scurlock Stroke Center, Houston Methodist, Houston, TX, USA.
Curr Neurol Neurosci Rep. 2020 Jun 30;20(8):35. doi: 10.1007/s11910-020-01055-1.
The purpose of this article is to review the current approaches using neuroimaging techniques to expand eligibility for intravenous thrombolytic therapy in acute ischemic stroke patients with stroke of unknown symptom onset.
In recent years, several randomized, placebo-controlled trials have shown neuroimaging-guided approaches to be feasible in determining eligibility for alteplase beyond 4.5 h from last known well, and efficacious for reducing disability. DWI-FLAIR mismatch on MRI is an effective tool to identify stroke lesions less than 4.5 h in onset in patients with stroke of unknown symptom onset. Additionally, an automated perfusion-based approach, assessing for a disproportionate amount of salvageable tissue, is effective in identifying patients likely to benefit from late window alteplase treatment. In patients with stroke of unknown symptom onset, an individualized approach using neuroimaging to determine time of stroke onset or presence of salvageable brain tissue is feasible in the acute setting and associated with improved long-term outcomes.
本文旨在综述目前使用神经影像学技术扩大急性缺血性脑卒中症状不明患者静脉溶栓治疗适应证的方法。
近年来，几项随机、安慰剂对照试验表明，神经影像学指导方法在确定发病后 4.5 小时以上应用阿替普酶的适应证方面是可行的，并且可以有效降低残疾程度。MRI 上的 DWI-FLAIR 不匹配是一种有效的工具，可用于识别发病时间小于 4.5 小时的症状不明的脑卒中患者的脑卒中病灶。此外，一种基于自动灌注的方法，评估不成比例的可挽救组织量，可有效识别可能从晚期窗阿替普酶治疗中获益的患者。对于症状不明的脑卒中患者，在急性发病期使用神经影像学来确定脑卒中发病时间或是否存在可挽救的脑组织，采用个体化方法是可行的，并且与改善长期预后相关。
