Ischaemic stroke
Ischaemic stroke
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DOI：
10.1038/s41572-019-0118-8
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发表时间：
2019-10-10
影响因子：
81.5
通讯作者：
Donnan, Geoffrey A.
中科院分区：
文献类型：
--
作者：
Campbell, Bruce C., V;De Silva, Deidre A.;Donnan, Geoffrey A.
•中风是全球第二大死亡原因，也是导致残疾的主要原因，发展中国家的发病率不断上升。由动脉闭塞引起的缺血性中风是大多数中风的原因。治疗的重点是快速再灌注静脉溶栓和血管内取栓，这两种方法都能减少残疾，但时间紧迫。因此，改善护理系统以减少治疗延误是最大限度地发挥再灌注治疗益处的关键。在中风发作后4.5小时内静脉溶栓可减少残疾。溶栓也有利于有可抢救脑组织灌注显像长达9小时证据的选定患者和伴有卒中症状的清醒患者。在卒中发作后6小时内和卒中发作后24小时内通过灌注成像选择的患者中，血管内血栓切除术可减少大血管闭塞患者的残疾。缺血性卒中的二级预防与其他领域的心血管风险管理有许多共同之处，包括血压控制、胆固醇管理和抗血栓药物治疗。其他预防干预措施是针对卒中机制量身定制的，例如房颤抗凝治疗和严重症状性颈动脉狭窄的颈动脉内膜切除术。
y Stroke is the second highest cause of death globally and a leading cause of disability, with an increasing incidence in developing countries. Ischaemic stroke caused by arterial occlusion is responsible for the majority of strokes. Management focuses on rapid reperfusion with intravenous thrombolysis and endovascular thrombectomy, which both reduce disability but are time-critical. Accordingly, improving the system of care to reduce treatment delays is key to maximizing the benefits of reperfusion therapies. Intravenous thrombolysis reduces disability when administered within 4.5 h of the onset of stroke. Thrombolysis also benefits selected patients with evidence from perfusion imaging of salvageable brain tissue for up to 9 h and in patients who awake with stroke symptoms. Endovascular thrombectomy reduces disability in a broad group of patients with large vessel occlusion when performed within 6 h of stroke onset and in patients selected by perfusion imaging up to 24 h following stroke onset. Secondary prevention of ischaemic stroke shares many common elements with cardiovascular risk management in other fields, including blood pressure control, cholesterol management and antithrombotic medications. Other preventative interventions are tailored to the mechanism of stroke, such as anticoagulation for atrial fibrillation and carotid endarterectomy for severe symptomatic carotid artery stenosis.