急性缺血性卒中血管再通治疗研究历程

急性缺血性卒中(acute ischemic stroke, AIS)是最常见的卒中类型, 具有高发病率、高死亡率、高致残率的特点。在时间窗内快速进行血管再通、实现血运重建、挽救缺血半暗带是治疗AIS的关键, 主要包括静脉溶栓治疗和血管内治疗。AIS血管再通治疗从静脉溶栓发展到血管内治疗, 经历了30多年的研究历程, 大致可分为3个阶段:第一阶段, 探索静脉溶栓药物, 开创卒中的静脉溶栓时代; 第二阶段, 探索溶栓药物更安全、有效的剂量和更合理的时间窗; 第三阶段, 取栓治疗兴起并飞速发展, 使AIS患者的治疗方法选择多样化、个体化, 根据患者的发病时间、严重程度及影像学改变等, 选择静脉溶栓治疗、桥接治疗(静脉溶栓联合血管内治疗)或单纯血管内治疗。

Rearch Course of Reperfusion Therapy for Acute Ischemic Stroke

Acute ischemic stroke(AIS), characterized by its high morbidity, high mortality, and high disability, is the most common subtype of stroke. Rapidly recanalizing the occluded arteries to salvage ischemic parenchyma in the early stage is essential to treat AIS, which mainly includes intravenous thrombolysis and endovascular treatment. The reperfusion therapy of AIS has been studied for over thirty years developing from intravenous thrombolysis(IVT) to endovascular treatment. There are three main stages in the evolution of reperfusion therapy:(1)investigating thrombolytic agents, which commenced the era of IVT in treating AIS; (2)investigating the dose and time window of thrombolytic agents to maximize the benefit and minimize the risk of IVT; (3)investigating mechanical thrombectomy for AIS, which contributes to the diversification and individualization of reperfusion therapy. Currently, IVT, bridging therapy, and direct mechanical thrombectomy can be applied to treating AIS according to the duration from the onset, the severity of clinical manifestation, and findings in the imaging examination.