Constitutively active ADAMTS13: An emerging thrombolytic agent for acute ischemic stroke.
Constitutively active ADAMTS13: An emerging thrombolytic agent for acute ischemic stroke.
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DOI：
10.1111/jth.15649
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发表时间：
2022-04
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--
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急性缺血性中风仍然是世界范围内致残率和致残率最高的原因之一。潜在的原因是动脉闭塞，这可能是由于心房颤动或瓣膜心脏病而导致的心脏栓塞，也可能是由于颈动脉或脑动脉的动脉粥样硬化而导致的动脉栓塞。目前，有效的再通治疗包括用重组组织型纤溶酶原激活剂(TPA)静脉溶栓，以降解血栓内的纤维蛋白，或血管内机械性血栓切除术，即借助先进的成像技术，使用支架取回器去除血栓。虽然这两种治疗方法都为血栓栓塞性中风患者提供了标准护理，但每种治疗方法都有各自的优点和局限性。例如，静脉溶栓的优势在于它可以适用于广泛的中风患者。然而，不幸的是，它只表现出适度的有效性[1]。在应用rtPA后，大约30%的中风患者观察到早期动脉再闭塞和不满意的长期结果[2]。此外，在大血管闭塞的患者中，成功再通的几率较低[3]。其他限制包括增加出血转化的风险，以及从卒中开始进行t-PA再灌注的治疗窗口狭窄，最长可达4.5小时。超过这一时间范围，大多数入院的中风患者不适合接受再灌注治疗，这大大限制了符合条件的人群[4]。另一方面，尽管血管内机械性血栓切除术更有效，但它只能应用于一小部分因大血管闭塞引起的中风患者[5]。近50%接受治疗的大血管闭塞的急性中风患者在血栓摘除后仍有神经功能障碍[6]。此外，一些患者没有资格接受机械血栓切除术，因为较大的梗塞无法挽救[7]。另一个限制是
Acute ischemic stroke remains one of the leading causes of morbidity and disability worldwide. The underlying cause is arterial occlusion, which might be cardioembolic because of atrial fibrillation or valvular heart disease, or arterioembolic because of atherosclerosis in the carotid artery or cerebral artery. Currently, effective reperfusion treatment includes intravenous thrombolysis with recombinant tissue plasminogen activator (tPA), which degrades fibrin within the thrombus, or endovascular mechanical thrombectomy, which involves the removal of thrombus with stent-retriever devices with the help of advanced imaging techniques. While both treatments provide standard care to patients with thromboembolic stroke, each of them has strengths and limitations. For example, the strength of intravenous thrombolysis is that it can be applied to a wide spectrum of stroke patients. Unfortunately, however, it exhibits only a modest effectiveness [1]. Early arterial re-occlusion and unsatisfactory long-term outcomes were observed in approximately 30% of stroke patients after rtPA administration [2]. In addition, successful recanalization is less often achieved in patients with large vessel occlusion [3]. Other limitations include increase risk of hemorrhagic transformation and the narrow therapeutic window of up to 4.5 hours for starting t-PA reperfusion from the stroke onset. Beyond this timeframe, most admitted stroke patients are not suitable for reperfusion therapy, which substantially limits the eligible population [4]. On the other hand, while endovascular mechanical thrombectomy is much more efficacious, it can only be applied in a small subset of patients with a stroke caused by a large vessel occlusion [5]. Nearly 50% of treated acute stroke patients with large vessel occlusion still experience neurological deficits after thrombectomy [6]. Furthermore, some patients are not eligible for mechanical thrombectomy because of larger infarcts that cannot be salvaged [7]. Another constraint is
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影响因子：
20.3
作者：
South, Kieron;Saleh, Ohud;Allan, Stuart M.
通讯作者：
Allan, Stuart M.
影响因子：
20.3
作者：
Banno, F;Kokame, K;Miyata, T
通讯作者：
Miyata, T
DOI：
10.1111/j.1538-7836.2012.04822.x
发表时间：
2012-08
期刊：
Journal of thrombosis and haemostasis : JTH
影响因子：
--
作者：
Khan MM;Motto DG;Lentz SR;Chauhan AK
通讯作者：
Chauhan AK
ADAMTS13：血栓形成与炎症之间的新联系。
影响因子：
15.3
作者：
Chauhan, Anil K.;Kisucka, Janka;Brill, Alexander;Walsh, Meghan T.;Scheiflinger, Friedrich;Wagner, Denisa D.
通讯作者：
Wagner, Denisa D.
影响因子：
20.3
作者：
Gandhi, Chintan;Khan, Mohammad Moshahid;Chauhan, Anil K.
通讯作者：
Chauhan, Anil K.