Imaging-guided acute ischemic stroke therapy: From "time is brain" to "physiology is brain".
Imaging-guided acute ischemic stroke therapy: From "time is brain" to "physiology is brain".
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发表时间：
2006-04
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通讯作者：
R. Gonzá Lez;Gilberto González
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作者：
R. Gonzá Lez;Gilberto González
实际接受急性缺血性中风治疗的潜在患者数量低得令人失望，有效的治疗对这一重大公共卫生问题影响甚微。成像并不经常用于识别缺血性半影区，这是中风生理学中的一个关键概念，尽管它能够以临床相关的方式做到这一点。越来越多的证据表明，识别缺血半暗带并根据其存在做出治疗决定对患者的预后有实质性的好处。此外，同样的研究表明，由于存在实质性的缺血半暗带，出人意料地有很大比例的患者适合接受治疗，远远超过了传统的时间窗口。现在广泛使用的现代MR成像和CT系统能够回答急性缺血性卒中最相关的生理学问题。这种能力为神经放射科医生提供了新的机会和责任，使适当的成像变得容易，并使成像数据得到快速处理和解释。本文综述了急性缺血性卒中的治疗，包括影像在当前医学实践中的作用，并提出了一种替代当代急性缺血性卒中治疗的循证选择。
The number of potential patients who are actually treated for acute ischemic stroke is disappointingly low, and effective treatments are making a minor impact on this major public health problem. Imaging is not regularly used to identify the ischemic penumbra, a key concept in stroke physiology, though it is capable of doing so in a clinically relevant manner. Evidence is accumulating that identification of the ischemic penumbra and making treatment decisions on the basis of its presence provide substantial benefit to patient outcomes. Moreover, the same studies suggest that an unexpectedly large proportion of patients are suitable for therapy well past the traditional time windows because of the existence of a substantial ischemic penumbra. Modern MR imaging and CT systems, now widely available, are capable of answering the most relevant physiologic questions in acute ischemic stroke. This capability presents new opportunities and responsibilities to neuroradiologists to make appropriate imaging readily available and to have the imaging data rapidly processed and interpreted. In this article, acute ischemic stroke therapy, including the role of imaging in current medical practice, is reviewed, and an evidence-based alternative to contemporary acute ischemic stroke therapy is suggested.