Liu L P, Yang Q W
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University. National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
Department of Neurology, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China.
Zhonghua Yi Xue Za Zhi. 2023 Aug 8;103(29):2207-2209. doi: 10.3760/cma.j.cn112137-20230619-01034.
Vascular recanalization therapy has been proven to be one of the most effective treatments for acute ischemic stroke (AIS) worldwide. Recently, the neurological functions have dramatically improved for AIS patients receiving endovascular thrombectomy, especially after the issue and promotion of evidence from different clinical studies. But nearly 50% of the patients had unfavorable clinical outcome even after successful recanalization [modified thrombolysis in cerebral infarction (mTICI)≥2b/3], which was termed as"futile recanalization". The mechanisms are complex, which may be related to poor collateral circulation, microthrombus and small artery reocclusion. The most significant pathophysiological change is brain tissue hypoperfusion although complete opening of the large artery, known as"no-reflow phenomenon". Therefore, it is urgent to manage the complications after vascular recanalization, such as hemorrhagic transformation, hyperperfusion syndrome, vascular re-occlusion, and even surgery-related complications (arterial dissection, contrast-induced encephalopathy), and future research is warranted to focus on the strategy of drugs with multi-target protection combined with vascular recanalization treatment. The current article covers the review, original research and case report focusing on this topic, aiming to raise clinical questions and call for more contribution to explore the mechanism and potential therapeutic strategy of futile recanalization, and thus provides more selections on the improvement of clinical outcome for AIS patients.
血管再通治疗已被证明是全球范围内治疗急性缺血性卒中（AIS）最有效的方法之一。最近，接受血管内血栓切除术的AIS患者神经功能有了显著改善，尤其是在不同临床研究的证据发布和推广之后。但即使成功再通[改良脑梗死溶栓（mTICI）≥2b/3]，仍有近50%的患者临床结局不佳，这被称为“无效再通”。其机制复杂，可能与侧支循环不良、微血栓和小动脉再闭塞有关。尽管大动脉完全开通，但最显著的病理生理变化是脑组织灌注不足，即“无复流现象”。因此，迫切需要处理血管再通后的并发症，如出血转化、高灌注综合征、血管再闭塞，甚至手术相关并发症（动脉夹层、造影剂诱导的脑病），未来的研究有必要聚焦于多靶点保护药物联合血管再通治疗的策略。本文涵盖了关于该主题的综述、原创研究和病例报告，旨在提出临床问题，呼吁更多人致力于探索无效再通的机制和潜在治疗策略，从而为改善AIS患者的临床结局提供更多选择。
