Seners Pierre, Baron Jean-Claude, Wouters Anke, Desilles Jean-Philippe, Pico Fernando, Macrez Richard, Olivot Jean-Marc, Lemmens Robin, Albers Gregory W, Lansberg Maarten G
Neurology Department, Rothschild Foundation Hospital, Paris, France (P.S.).
Institut de Psychiatrie et Neurosciences de Paris, U1266, INSERM, France (P.S., J.-C.B.).
Stroke. 2025 Feb;56(2):564-574. doi: 10.1161/STROKEAHA.124.049167. Epub 2024 Nov 6.
Currently, most acute ischemic stroke patients presenting with a large vessel occlusion are first evaluated at a nonthrombectomy-capable center before transfer to a comprehensive stroke center that performs thrombectomy. Interfacility transfer is a complex process that requires extensive coordination between the referring, transporting, and receiving facilities. As a result, long delays are common, contributing to poor clinical outcomes. In this review, we summarize the accumulating literature about the clinical as well as radiological-infarct growth, collateral change, arterial recanalization, and hemorrhagic transformation-changes during interfacility transfer for thrombectomy. Recent evidence shows that clinical/radiological changes during transfer are heterogeneous across patients and impact long-term functional outcomes, highlighting the urgent need to optimize care during this time window. We review some of the most promising therapeutic strategies-for example, penumbral protection to reduce infarct growth-that may improve clinical outcome in patients being transferred to thrombectomy-capable centers. Finally, we discuss key methodological considerations for designing clinical trials aimed at reducing infarct growth during transfer.
目前，大多数出现大血管闭塞的急性缺血性中风患者首先在无血栓切除术能力的中心接受评估，然后再转至进行血栓切除术的综合中风中心。机构间转运是一个复杂的过程，需要转诊机构、转运机构和接收机构之间进行广泛协调。因此，长时间延误很常见，这导致了较差的临床结果。在本综述中，我们总结了关于机构间转运至血栓切除术中心过程中临床以及梗死灶扩大、侧支循环变化、动脉再通和出血转化等影像学变化的越来越多的文献。最近的证据表明，转运过程中的临床/影像学变化在患者之间存在异质性，并影响长期功能结局，这凸显了在此时间窗内优化治疗的迫切需求。我们回顾了一些最有前景的治疗策略，例如半暗带保护以减少梗死灶扩大，这可能改善转至有血栓切除术能力中心的患者的临床结局。最后，我们讨论了旨在减少转运过程中梗死灶扩大的临床试验设计的关键方法学考虑因素。
