Department of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8072, St. Louis, MO, 63110, USA.
Neurotherapeutics. 2023 Apr;20(3):655-663. doi: 10.1007/s13311-023-01371-7. Epub 2023 Mar 28.
Thrombectomy became the gold-standard treatment of acute ischemic stroke caused by large-vessel occlusions (LVO) in 2015 after five clinical trials published that year demonstrated significantly improved patient outcomes. In subsequent years, advances in stroke systems of care have centered around improving access to and expanding patient eligibility for thrombectomy. The prehospital and acute stroke treatment settings have had the greatest emphasis. Numerous prehospital stroke scales now provide emergency medical services with focused physical exams to identify LVOs, and many devices to non-invasively detect LVO are undergoing clinical testing. Mobile stroke units deployed throughout Western Europe and the USA also show promising results by bringing elements of acute stroke care directly to the patient. Numerous clinical trials since 2015 have aimed to increase candidates for thrombectomy by expanding indications and the eligibility time window. Further optimizations of thrombectomy treatment have focused on the role of thrombolytics and other adjunctive therapies that may promote neuroprotection and neurorecovery. While many of these approaches require further clinical investigation, the next decade shows significant potential for further advances in stroke care.
取栓术在 2015 年成为治疗大血管闭塞（LVO）引起的急性缺血性脑卒中的金标准治疗方法，当年发表的五项临床试验表明，患者的预后明显改善。在随后的几年中，卒中治疗系统的进展集中在改善取栓术的可及性和扩大患者的适应证上。在院前和急性卒中治疗环境中，这一重点最为突出。现在有许多院前卒中量表为急救医疗服务提供了重点体格检查，以识别 LVO，并正在对许多用于非侵入性检测 LVO 的设备进行临床测试。在西欧和美国部署的移动卒中单元也通过直接将急性卒中护理的各个要素带到患者身边，取得了有前景的结果。自 2015 年以来，许多临床试验旨在通过扩大适应证和延长时间窗来增加取栓术的候选人群。进一步优化取栓治疗的重点是溶栓药物和其他辅助治疗的作用，这些治疗可能有助于神经保护和神经恢复。虽然这些方法中的许多都需要进一步的临床研究，但未来十年显示出卒中治疗进一步进展的巨大潜力。
