Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA; Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Lancet. 2024 Sep 28;404(10459):1265-1278. doi: 10.1016/S0140-6736(24)01410-7.
Stroke related to large vessel occlusion is a leading cause of disability and death worldwide. Advances in endovascular therapy to reopen occluded arteries have been shown to reduce patient disability and mortality. Expanded indications to treat patients with large vessel occlusion in the late window (>6 h from symptom onset), with basilar artery occlusion, and with large ischaemic core at presentation have enabled treatment of more patients with simplified imaging methods. Ongoing knowledge gaps include an understanding of which patients with large ischaemic infarct are more likely to benefit from endovascular therapy, the role of endovascular therapy in patients who present with low National Institutes of Health Stroke Scale scores or medium or distal vessel occlusion, and optimal management of patients with underlying intracranial atherosclerotic disease. As reperfusion can now be facilitated by intravenous thrombolysis, mechanical thrombectomy, or both, the development of cytoprotective or adjunctive drugs to slow infarct growth, enhance reperfusion, or decrease haemorrhagic risk has gained renewed interest with the hope to improve patient outcomes.
与大血管闭塞相关的中风是全球范围内导致残疾和死亡的主要原因。血管内治疗以重新开通闭塞动脉的进展已被证明可以降低患者的残疾和死亡率。扩大适应证以治疗在晚期窗口（症状发作后>6 小时）、基底动脉闭塞和出现大缺血核心的大血管闭塞患者，以及简化成像方法，使更多的患者能够接受治疗。目前仍存在知识空白，包括了解哪些大缺血性梗死患者更有可能从血管内治疗中获益，血管内治疗在 NIHSS 评分较低或中等或远端血管闭塞患者中的作用，以及颅内动脉粥样硬化疾病患者的最佳治疗方法。由于现在可以通过静脉溶栓、机械取栓或两者联合来实现再灌注，因此人们对细胞保护或辅助药物以减缓梗死生长、增强再灌注或降低出血风险产生了新的兴趣，以期改善患者的预后。
