Fieschi C, Cavalletti C, Toni D, Fiorelli M, Sacchetti M L, De Michele M, Gori M C, Montinaro E, Argentino C
Department of Neurological Sciences, University of Rome La Sapienza, Italy.
Acta Neurochir Suppl. 1996;66:76-80. doi: 10.1007/978-3-7091-9465-2_14.
Thrombolysis is an attractive but potentially dangerous they for cerebral ischemia: it is capable of dissolving an arterial thrombus, but can also transform a pale infarct into a hematoma and/or may cause severe oedema and herniation. The safety and efficacy of the treatment critically depend on the timing of intervention ad on patient selection. In recent studies on ischemic stroke, spontaneous hemorrhagic transformation of an infarct seems to be related to the size of the lesion, and can be reliably predicted as early as five hours from stroke onset by the presence of focal hypodensity in the CT scan. That is why in the European Co-operative Acute Stroke (ECASS), a randomised, double blind trial on intravenous rt-PA in hemispheric stroke, patients showing, on the admission CT scan, extended early hypodensity, involving more than one third of the territory of the middle cerebral artery, were excluded from the day. Other ongoing trials on thrombolytic agents are expected to provide further indications on how to identify those patients most likely to benefit and least likely to experience adverse effects from this treatment.
它能够溶解动脉血栓，但也可能将缺血性梗死转变为血肿和/或导致严重水肿及脑疝。治疗的安全性和有效性关键取决于干预时机和患者选择。在近期关于缺血性卒中的研究中，梗死灶的自发性出血转化似乎与病灶大小有关，并且早在卒中发作后五小时，通过CT扫描中局灶性低密度影的存在就能可靠地预测。这就是为什么在欧洲急性卒中协作研究（ECASS）中，一项关于半球性卒中静脉注射rt-PA的随机双盲试验中，那些在入院CT扫描时显示早期低密度影扩展、累及大脑中动脉供血区超过三分之一的患者被排除在外。其他正在进行的关于溶栓药物的试验有望为如何识别最可能从该治疗中获益且最不可能出现不良反应的患者提供进一步的指导。
