Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, 92354, USA.
Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China.
Transl Stroke Res. 2021 Jun;12(3):382-393. doi: 10.1007/s12975-020-00877-y. Epub 2020 Nov 20.
Stroke has become the second most prevalent cause of mortality in the world. Currently, the treatment of ischemic stroke is based on thrombolytic and thrombectomy therapy shortly after the ischemic event (≤ 4.5 h for thrombolytic strategies; ≤ 6 h for thrombectomy strategies). However, the majority of patients are unable to receive prompt treatment, particularly in undeveloped countries. Alternative solutions are lacking for those patients that miss the optimal window of opportunity for treatment. Recently, new developments in imaging techniques and intravascular interventional devices enable the expansion of the window of opportunity for treating stroke patients. Clinical studies have reported that delayed recanalization at 24 h, or even more than 1 month, was beneficial for some patients. However, the mechanisms of neuroprotection that underly the delayed recanalization in these ischemic stroke patients remain unclear. In this review, we will summarize the clinical studies of delayed recanalization, and organize them according to the duration of occlusion. Additionally, we will discuss the changing guidelines and possible mechanisms based on animal research, and attempt to draw conclusions and future perspectives.
脑卒中已成为全球第二大致死病因。目前，缺血性脑卒中的治疗主要基于缺血事件发生后（溶栓策略为≤4.5 h；取栓策略为≤6 h）的溶栓和取栓治疗。然而，大多数患者无法及时得到治疗，尤其是在欠发达国家。对于那些错过最佳治疗时机的患者，目前还缺乏替代治疗方案。最近，成像技术和血管内介入器械的新发展，为治疗脑卒中患者扩大了治疗时机的窗口。临床研究报告称，24 小时甚至 1 个月后再通对某些患者有益。然而，这些缺血性脑卒中患者延迟再通的神经保护机制尚不清楚。在本综述中，我们将根据闭塞时间对延迟再通的临床研究进行总结，并进行讨论。此外，我们还将根据动物研究讨论不断变化的指南和可能的机制，并尝试得出结论和展望未来。
