Cheng Zhe, Wang Hongrui, Geng Xiaokun, Rajah Gary B, Elmadhoun Omar, Peng Guangge, Ding Yuchuan
Department of Neurology and the Stroke Intervention & Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, China.
Luhe Institute of Neuroscience, Capital Medical University, Beijing, China.
Aging Dis. 2024 Oct 28. doi: 10.14336/AD.2024.1024.
Reperfusion strategies such as vascular thrombolysis and thrombectomy are the first-line treatments recommended for acute ischemic stroke. However, only half of these patients achieve functional independence after endovascular reperfusion of large vessel occlusions. Timely restoration of blood flow is crucial, but not all reperfusion results in benefit, a phenomenon termed futile reperfusion. Futile reperfusion occurs when brain tissue has already suffered irreversible damage before reperfusion or when other factors undermine the benefits of restored blood flow. These factors include reperfusion-not rescued injury, reperfusion-induced injury, and the no-reflow phenomenon. The success of reperfusion therapies also hinges on timing and tissue condition after stroke. Defining these time and tissue windows more precisely could refine stroke interventions, potentially expanding effective reperfusion opportunities tailored to individual patients, thereby reducing the incidence of futile reperfusion. This perspective article delves into the complexities of futile reperfusion and the critical roles of time and tissue windows in determining stroke outcomes.
血管溶栓和血栓切除术等再灌注策略是推荐用于急性缺血性卒中的一线治疗方法。然而，在大血管闭塞的血管内再灌注治疗后，只有一半的患者能够实现功能独立。及时恢复血流至关重要，但并非所有再灌注都能带来益处，这种现象被称为无效再灌注。当脑组织在再灌注前已经遭受不可逆损伤，或者其他因素削弱了恢复血流的益处时，就会发生无效再灌注。这些因素包括再灌注未挽救损伤、再灌注诱导损伤和无复流现象。再灌注治疗的成功还取决于卒中后的时间和组织状况。更精确地定义这些时间和组织窗可以优化卒中干预措施，有可能扩大针对个体患者的有效再灌注机会，从而降低无效再灌注的发生率。这篇观点文章深入探讨了无效再灌注的复杂性以及时间和组织窗在决定卒中结局中的关键作用。
