Selection of thrombolytic therapy beyond 3 h using magnetic resonance imaging
Selection of thrombolytic therapy beyond 3 h using magnetic resonance imaging
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DOI：
10.1097/00019052-200502000-00010
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发表时间：
2005-02-01
影响因子：
4.8
通讯作者：
Parsons, M
中科院分区：
文献类型：
--
作者：
Davis, SM;Donnan, GA;Parsons, M
综述目的：由于关键性临床试验证明了3小时的时间窗，因此缺血性卒中静脉溶栓治疗的使用被限制在3小时的时间窗内。溶栓的目的是闭塞动脉的再通和缺血半暗带的再灌注，缺血半暗带是严重低灌注、功能受损但可能存活的脑区域。目前有许多前瞻性试验正在验证这样的假设，即半暗带的存在将预测超过3小时的溶栓反应。最近的发现使用磁共振成像，较大的灌注加权成像病变和较小的弥散加权成像病变之间的不匹配被认为是代表缺血半暗带。灌注加权成像提供半定量脑血流成像，弥散加权成像是大部分不可逆缺血核心的指标。这一定义已被修改的认识，灌注加权成像病变包括良性少血，扩散加权成像核心的一部分是潜在的挽救与快速再灌注。大多数急性卒中患者在卒中发作后6小时内具有磁共振成像半影特征。半暗带通常但并非总是与近端动脉闭塞相关，并且具有时间依赖性。初步研究表明，溶栓治疗的好处超出了既定的3-h窗口。SummaryPenumbral成像使用磁共振成像与灌注扩散加权成像不匹配可以提供一个生理“组织时钟”在个别患者。基于这一假设，正在进行一些前瞻性试验。这些公司包括EPITHET、DEFUSE、DIAS、MR RESCUE和ROSIE。
Purpose of reviewUse of intravenous thrombolytic therapy in ischaemic stroke is restricted to a 3-h time window because of the proof of this time window in pivotal clinical trials. Thrombolysis is aimed at recanalization of occluded arteries and reperfusion of the ischaemic penumbra, a region of critically hypoperfused, functionally impaired, but potentially viable brain. There are a number of current prospective trials that are testing the hypothesis that the presence of the penumbra will predict thrombolytic responders beyond 3 h.Recent findingsUsing magnetic resonance imaging, a mismatch between a larger perfusion-weighted imaging lesion and smaller diffusion-weighted imaging lesion is considered to represent the ischaemic penumbra. Perfusion-weighted imaging provides semiquantitative cerebral blood flow imaging and diffusion-weighted imaging is an index of the largely irreversible ischaemic core. This definition has been modified with the recognition that the perfusion-weighted imaging lesion includes benign oligaemia and that a portion of the diffusion-weighted imaging core is potentially salvageable with rapid reperfusion. Most acute stroke patients have a magnetic resonance imaging-penumbral signature within 6 h of stroke onset. The penumbra is commonly, but not invariably, associated with proximal arterial occlusion and is time-dependent. Preliminary studies have shown benefit from thrombolytic therapy beyond the established 3-h window.SummaryPenumbral imaging using magnetic resonance imaging with perfusion over diffusion weighted imaging mismatch can provide a physiological 'tissue clock' in individual patients. Based on this hypothesis, a number of prospective trials are being performed. These include EPITHET, DEFUSE, DIAS, MR RESCUE and ROSIE.