Department of Neurological Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital.
Stroke. 2023 Sep;54(9):2472-2480. doi: 10.1161/STROKEAHA.123.044240. Epub 2023 Aug 3.
Acute ischemic stroke remains the primary cause of disability worldwide. For patients with large vessel occlusions, intravenous thrombolysis followed by mechanical thrombectomy remains the standard of care. Revascularization of the large vessel is typically successful. However, despite reopening of the occluded vessel, many patients fail to return to independence. Functional failure, despite macrovascular recanalization, is often referred to as the no-reflow phenomenon. Even with an extensive characterization of reperfusion in animal models, numerous mechanisms may explain no-reflow. Further, uniform measurements of this microvascular dysfunction and prognostic markers associated with no-reflow are lacking. In this review, we highlight a number of mechanisms that may explain no-reflow, characterize current multimodal measurements, and assess its molecular markers.
急性缺血性脑卒中仍然是全球范围内致残的主要原因。对于大血管闭塞的患者，静脉溶栓联合机械取栓仍然是标准的治疗方法。大血管的再通通常是成功的。然而，尽管闭塞的血管已经重新开放，许多患者仍无法恢复独立生活。尽管大血管再通，但功能恢复失败通常被称为无再流现象。即使在动物模型中对再灌注进行了广泛的特征描述，也可能有许多机制可以解释无再流。此外，还缺乏对这种微血管功能障碍的统一测量以及与无再流相关的预后标志物。在这篇综述中，我们强调了一些可能解释无再流的机制，描述了当前的多模态测量方法，并评估了其分子标志物。
