再灌注治疗决策策略：穿越卒中试验的空白。
Decision-making strategies for reperfusion therapies: navigating through stroke trials gaps.
机构信息
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo, SP, Brazil.
Hospital de Base do Distrito Federal, Brasília, DF, Brazil.
出版信息
Arq Neuropsiquiatr. 2022 May;80(5 Suppl 1):60-71. doi: 10.1590/0004-282X-ANP-2022-S123.
Abstract
Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.
摘要
尽管有大量关于急性缺血性脑卒中治疗的文献和众多随机临床试验，但这些试验并未包括一些常见的有争议的情况，对于这些情况，临床实践中急需制定决策策略。本文试图总结目前一些选定情况（低 ASPECT 评分患者的机械取栓、近端闭塞的低 NIHSS 评分患者、急性基底动脉闭塞、远端和中等血管闭塞等）的证据，就如何在临床实践中处理这些情况提出建议，并展示急性脑卒中研究在不久的将来的预期结果。
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本文引用的文献
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Mechanical thrombectomy of acute occlusions of individual distal anterior cerebral artery branches.机械取栓治疗急性孤立性大脑前动脉远端分支闭塞
J Clin Neurosci. 2022 Apr;98:137-141. doi: 10.1016/j.jocn.2022.02.003. Epub 2022 Feb 15.
2
Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial.成功取栓后动脉内注射阿替普酶与安慰剂对大血管闭塞性急性缺血性脑卒中患者功能结局的影响：CHOICE 随机临床试验。
JAMA. 2022 Mar 1;327(9):826-835. doi: 10.1001/jama.2022.1645.
3
Endovascular Therapy for Acute Stroke with a Large Ischemic Region.针对大面积缺血区域急性卒中的血管内治疗
N Engl J Med. 2022 Apr 7;386(14):1303-1313. doi: 10.1056/NEJMoa2118191. Epub 2022 Feb 9.
4
The Benefit of Thrombectomy in Patients With Low ASPECTS Is a Matter of Shades of Gray-What Current Trials May Have Missed.低ASPECTS患者行血栓切除术的益处存在灰色地带——当前试验可能遗漏的内容。
Front Neurol. 2022 Jan 14;12:718046. doi: 10.3389/fneur.2021.718046. eCollection 2021.
5
Clinical presentation of posterior cerebral artery occlusions - Clinical rationale for a more aggressive therapeutic strategy?大脑后动脉闭塞的临床表现——更积极治疗策略的临床依据？
eNeurologicalSci. 2021 Sep 4;25:100368. doi: 10.1016/j.ensci.2021.100368. eCollection 2021 Dec.
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Neurology. 2021 Nov 16;97(20):e1975-e1985. doi: 10.1212/WNL.0000000000012863. Epub 2021 Oct 14.
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