Eastin T Marc, Dye Justin A, Pillai Promod, Lopez-Gonzalez Miguel A, Huang Lei, Zhang John H, Boling Warren W
Department of Neurological Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States.
Department of Pharmacology and Physiology, Loma Linda University, Loma Linda, CA, United States.
Front Pharmacol. 2023 Feb 8;14:1124263. doi: 10.3389/fphar.2023.1124263. eCollection 2023.
Stroke shares a significant burden of global mortality and disability. A significant decline in the quality of life is attributed to the so-called post-stroke cognitive impairment including mild to severe cognitive alterations, dementia, and functional disability. Currently, only two clinical interventions including pharmacological and mechanical thrombolysis are advised for successful revascularization of the occluded vessel. However, their therapeutic effect is limited to the acute phase of stroke onset only. This often results in the exclusion of a significant number of patients who are unable to reach within the therapeutic window. Advances in neuroimaging technologies have allowed better assessment of salvageable penumbra and occluded vessel status. Improvement in diagnostic tools and the advent of intravascular interventional devices such as stent retrievers have expanded the potential revascularization window. Clinical studies have demonstrated positive outcomes of delayed revascularization beyond the recommended therapeutic window. This review will discuss the current understanding of ischemic stroke, the latest revascularization doctrine, and evidence from clinical studies regarding effective delayed revascularization in ischemic stroke.
中风是全球死亡和残疾的重大负担。生活质量的显著下降归因于所谓的中风后认知障碍,包括轻度至重度认知改变、痴呆和功能残疾。目前,对于闭塞血管的成功再通,仅建议两种临床干预措施,即药物溶栓和机械溶栓。然而,它们的治疗效果仅局限于中风发作的急性期。这常常导致大量无法在治疗窗内就诊的患者被排除在外。神经成像技术的进步使得对可挽救的半暗带和闭塞血管状态有了更好的评估。诊断工具的改进以及血管内介入装置如取栓支架的出现扩大了潜在的再通窗。临床研究已经证明了在推荐治疗窗之外进行延迟再通的积极结果。本综述将讨论对缺血性中风的当前认识、最新的再通学说以及关于缺血性中风有效延迟再通的临床研究证据。