Current status of endovascular stroke treatment.
Current status of endovascular stroke treatment.
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DOI：
10.1161/circulationaha.110.971564
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发表时间：
2011-06-07
期刊：
影响因子：
37.8
通讯作者：
Higashida RT
中科院分区：
文献类型：
--
作者：
Meyers PM;Schumacher HC;Connolly ES Jr;Heyer EJ;Gray WA;Higashida RT
中风是美国、加拿大、欧洲和日本的第三大死因。根据美国心脏协会的统计，现在美国每年有79.5万例新中风，导致20万人死亡，即每16例死亡中就有1例死亡。缺血性中风占总数的80%，出血性中风占其余部分。中风是北美成年人残疾的主要原因，也是长期成人医疗保险报销的主要原因。美国国立卫生研究院（NIH）估计，美国每年因中风造成的医疗费用超过730亿美元。需要改进治疗方法，以减轻人类痛苦的负担，减轻社会的经济负担。从流行病学角度来看，美国每年有79.5万例中风1，但这个数字并不代表可治疗中风的数量。能够接受某种形式的血管内血运重建干预的缺血性中风的实际数量可能只是总数的一小部分。这种差异至少在一定程度上解释了，与心脏干预的快速发展相比，中风试验登记和科学进步的进展相对缓慢。由于许多急性缺血性中风是由于出血、小血管闭塞（腔隙性中风）、短暂性缺血性发作、晚期中风和轻度中风所致，因此不需要进行血管内手术的风险，因此每年可能需要紧急干预的急性中风数量在5.8万至12万之间，占总数的7%至15%。在大多数社区，只有1%至7%的中风患者及时到达医院接受中风血运重建治疗。即使在有高度组织和积极的中风项目的社区，10%的中风患者也能立即得到治疗。即使这样的项目在美国建立起来，58000名中风患者（64.5万缺血性中风患者中的9%）将接受治疗。2 .可能需要血管内介入治疗的人数尚不清楚。许多患者在入院时已经出现了大面积的脑损伤。在遵循循证干预指南的综合卒中中心，血管内缺血性卒中手术仍然是神经介入医师实施的最不常见的手术（平均每年8例）。4
Stroke is the third-leading cause of death in the United States, Canada, Europe, and Japan. According to American Heart Association statistics, there are now 795 000 new strokes each year, resulting in 200 000 deaths, or 1 of every 16 deaths, per year in the United States. 1 Ischemic stroke represents 80% of the total, and hemorrhagic stroke makes up the remainder. Stroke is the leading cause of adult disability in both North America and Medicare reimbursement for long-term adult care. The National Institutes of Health (NIH) estimate that stroke costs exceed $73 billion in US healthcare dollars per year. 1 Improved treatments are needed to reduce the burden of human suffering and to lessen the financial burden on society.Epidemiologically, there are 795 000 strokes per year in the United States, 1 but this number does not represent the number of treatable strokes. The real number of ischemic strokes amenable to some form of endovascular revascularization intervention is probably a small subset of the total number. This disparity explains, at least in part, the relatively slow progress in stroke trial enrollment and scientific progress compared with the more rapid development of cardiac interventions. The number of acute strokes potentially requiring emergent intervention ranges from 58 000 to 120 000 per year, or 7% to 15% of the total number, because many acute ischemic strokes are due to hemorrhage, small-vessel occlusions (lacunar strokes), transient ischemic attacks, end-of-life strokes, and mild strokes that do not warrant the risk of an endovascular procedure. 2 In most communities, only 1% to 7% of stroke victims arrive at hospital in time for stroke revascularization therapies. Even in communities with highly organized and active stroke programs, 10% of stroke victims receive immediate treatment. 3 Even if such programs were instituted across the United States, 58 000 stroke victims (9% of 645000 ischemic stroke patients) would receive treatment. 2 The number potentially needing an endovascular intervention is less clear. Extensive brain injury is already present in many patients on admission. In comprehensive stroke centers following evidence-based guidelines for intervention, endovascular ischemic stroke procedures remain among the least common procedures that neurointerventionalists perform (on average, 8 procedures per year). 4