Ahmed Zubair, Pan Jeremy, Eskandar Tony, Agrawal Devendra K
Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766, USA.
Cardiol Cardiovasc Med. 2024;8(6):504-514. Epub 2024 Dec 10.
Universally, stroke presents as neurological deficits due to the obstruction of blood supply to specific regions of the brain. Among the three main categories of stroke, acute ischemic stroke is the leading cause of death and disability worldwide. As of today, there are two effective treatment methods: thrombolysis and endovascular therapy. Intravenous thrombolysis treatment via tissue plasminogen activator is typically administered within 4.5 hours from the onset of symptoms. Mechanical thrombectomy, a type of endovascular therapy, is indicated for acute ischemic stroke due to a large vessel occlusion occurring within 24 hours since the patient was last seen asymptomatic. Due to the disadvantages of intravenous thrombolysis treatment, such as a limited time window and numerous contraindications, studies have proven the efficacy of mechanical thrombectomy as the standard of care for acute ischemic stroke due to large vessel occlusion in the anterior circulation. Endovascular therapy was associated with higher rates of independent clinical outcome and successful reperfusion rates compared to intravenous thrombolysis treatment. Currently, stent retrievers and aspiration devices are the two most common endovascular therapy techniques. Two prominent studies compared the reperfusion rates between these two techniques, but neither was found to be more beneficial than the other. The decision to use either a stent retriever or direct aspiration depends on the patient and the thrombus involved. This comprehensive article critically discusses the findings on the efficacy of mechanical thrombectomy therapy for acute ischemic stroke and its associated outcomes and complications.
普遍而言，中风表现为因大脑特定区域血液供应受阻而导致的神经功能缺损。在中风的三大主要类型中，急性缺血性中风是全球范围内导致死亡和残疾的主要原因。截至目前，有两种有效的治疗方法：溶栓治疗和血管内治疗。通过组织纤溶酶原激活剂进行静脉溶栓治疗通常在症状发作后的4.5小时内进行。机械取栓术作为一种血管内治疗方法，适用于因患者最后一次无症状后24小时内发生的大血管闭塞所致的急性缺血性中风。由于静脉溶栓治疗存在时间窗有限和诸多禁忌症等缺点，研究已证实机械取栓术作为前循环大血管闭塞所致急性缺血性中风的标准治疗方法的有效性。与静脉溶栓治疗相比，血管内治疗的独立临床预后率和成功再灌注率更高。目前，支架取栓器和抽吸装置是两种最常见的血管内治疗技术。两项著名研究比较了这两种技术之间的再灌注率，但均未发现其中一种比另一种更具优势。选择使用支架取栓器还是直接抽吸取决于患者和所涉及的血栓。这篇综合性文章批判性地讨论了机械取栓术治疗急性缺血性中风的疗效及其相关预后和并发症的研究结果。
