Critical early thrombolytic and endovascular reperfusion therapy for acute ischemic stroke victims: a call for adjunct neuroprotection.
Critical early thrombolytic and endovascular reperfusion therapy for acute ischemic stroke victims: a call for adjunct neuroprotection.
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DOI：
10.1007/s12975-015-0419-5
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发表时间：
2015-10
影响因子：
6.9
通讯作者：
Lapchak PA
中科院分区：
文献类型：
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作者：
Lapchak PA
今天，由于最近MR. CLEAN、SWIFT PRIME、ESCAPE、EXTEND-IA和REVASCAT血管内试验的成功，中风患者护理领域出现了大量令人兴奋的成果。成功的静脉（IV）重组组织纤溶酶原激活（rt-PA）临床试验[即：美国国家神经退行性疾病和卒中研究所（NINDS）卒中试验；第三次欧洲急性卒中合作研究（ECASSIII）和第三次国际卒中研究（IST-3）]也需要强调。在最近的血管内和溶栓试验中，使用美国国立卫生研究院卒中量表（NIHSS）和修改后的Rankin评分（mRS）量表都有统计学上的显著改善，但两种方法都不能促进任何特定NIHSS或mRS评分等级的患者完全康复。血管内治疗的绝对改善（90天mRS 0-2）为13.5-31%，而单独溶栓也能显著改善患者的功能独立性，但程度较低（NINDS rt-PA试验13%）。本文有3个主要目的：(1)首先强调rt-PA治疗脑卒中的效用和成本效益；(2)其次回顾近期血管内试验作为卒中治疗的疗效、安全性和成本效益；(3)进一步考虑和评估开发新型神经保护药物的策略。本文将提出一篇论文，以便未来的中风试验和治疗发展能够最佳地促进康复，使中风患者能够回归“正常”生活。
Today, there is an enormous amount of excitement in the field of stroke victim care due to the recent success of MR. CLEAN, SWIFT PRIME, ESCAPE, EXTEND-IA, and REVASCAT endovascular trials. Successful intravenous (IV) recombinant tissue plasminogen activation (rt-PA) clinical trials [i.e.: National Institutes of Neurodegenerative Disease and Stroke (NINDS) stroke trial; Third European Cooperative Acute Stroke Study (ECASSIII) and Third International Stroke study (IST-3)] also need to be emphasized. In the recent endovascular and thrombolytic trials, there is statistically significant improvement using both the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Score (mRS) scale, but neither approach promotes complete recovery in patients enrolled within any particular NIHSS or mRS score tier. Absolute improvement (mRS 0–2 at 90 days) with endovascular therapy is 13.5–31%, whereas thrombolytics alone also significantly improve patient functional independence, but to a lesser degree (NINDS rt-PA trial 13%). This article has 3 main goals: (1) first to emphasize the utility and cost-effectiveness of rt-PA to treat stroke; (2) second to review the recent endovascular trials with respect to efficacy, safety and cost-effectiveness as a stroke treatment; and (3) to further consider and evaluate strategies to develop novel neuroprotective drugs. A thesis will be put forth so that future stroke trials and therapy development can optimally promote recovery so that stroke victims can return to “normal” life.