Sporns Peter B, Fiehler Jens, Ospel Johanna, Safouris Apostolos, Hanning Uta, Fischer Urs, Goyal Mayank, McTaggart Ryan, Brehm Alex, Psychogios Marios
Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland.
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ther Adv Neurol Disord. 2021 Mar 16;14:1756286421998905. doi: 10.1177/1756286421998905. eCollection 2021.
Endovascular thrombectomy (EVT) has become standard of care for large vessel occlusion strokes but current guidelines exclude a large proportion of patients from this highly effective treatment. This review therefore focuses on expanding indications for EVT in several borderline indications such as patients in the extended time window, patients with extensive signs of infarction on admission imaging, elderly patients and patients with pre-existing deficits. It also discusses the current knowledge on intravenous thrombolysis as an adjunct to EVT and EVT as primary therapy for distal vessel occlusions, for tandem occlusions, for basilar artery occlusions and in pediatric patients. We provide clear recommendations based on current guidelines and further literature.
血管内血栓切除术（EVT）已成为大血管闭塞性卒中的标准治疗方法，但目前的指南将很大一部分患者排除在这种高效治疗之外。因此，本综述着重于扩大EVT在几个临界适应症中的应用指征，例如处于延长时间窗的患者、入院影像学检查显示有广泛梗死迹象的患者、老年患者以及有既往神经功能缺损的患者。它还讨论了关于静脉溶栓作为EVT辅助治疗以及EVT作为远端血管闭塞、串联闭塞、基底动脉闭塞和儿科患者的主要治疗方法的现有知识。我们根据当前指南和进一步的文献提供了明确的建议。
