Robbins Blake T, Howington Gavin T, Swafford Kara, Zummer Jaryd, Woolum Jordan A
Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA.
Department of Pharmacy Practice and Science University of Kentucky College of Pharmacy Lexington Kentucky United States.
J Am Coll Emerg Physicians Open. 2023 Feb 15;4(1):e12896. doi: 10.1002/emp2.12896. eCollection 2023 Feb.
Primary literature detailing updated management principles of acute ischemic stroke outpaces current guidelines, resulting in heterogenous practices. Recent advancements in neuroimaging have shifted treatment from a time-based approach to an individualized, image-guided appraisal directed by the presence or absence of salvageable brain tissue. In addition, tenecteplase appears to be a safe and effective for the treatment of acute ischemic stroke and is becoming an attractive agent due to its practical administration. Several factors must be accounted for when implementing tenecteplase into the health-system including cost, education, and changes in clinician workflows. Larger studies with broad patient populations are needed to more definitively evaluate whether intravenous thrombolytics should be used in combination with endovascular thrombectomy in patients with anterior large-vessel occlusions. Although debate regarding the safety and efficacy of various endovascular therapies, delays encountered in the identification, triage, and care of acute ischemic stroke patients increase the likelihood of necrotic core lesion development and loss of salvageable penumbra.
详细阐述急性缺血性中风最新管理原则的原始文献超过了当前指南，导致实践方法各异。神经影像学的最新进展已将治疗从基于时间的方法转变为根据是否存在可挽救脑组织进行个体化、图像引导评估的方法。此外，替奈普酶似乎是治疗急性缺血性中风的一种安全有效的药物，由于其给药方式简便，正成为一种有吸引力的药物。在将替奈普酶应用于医疗系统时，必须考虑几个因素，包括成本、教育以及临床医生工作流程的变化。需要开展针对更广泛患者群体的更大规模研究，以更明确地评估对于前循环大血管闭塞患者，静脉溶栓是否应与血管内血栓切除术联合使用。尽管对于各种血管内治疗的安全性和有效性存在争议，但急性缺血性中风患者在识别、分诊和治疗过程中遇到的延误增加了坏死核心病变发展以及可挽救半暗带丧失的可能性。
