Future directions of acute ischaemic stroke therapy
Future directions of acute ischaemic stroke therapy
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DOI：
10.1016/s1474-4422(15)00054-x
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发表时间：
2015-07-01
期刊：
影响因子：
48
通讯作者：
Saver, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Fisher, Marc;Saver, Jeffrey L.
几年来，阿替普酶是急性缺血性卒中唯一有效的治疗方法，已批准在4年内使用。在许多国家，卒中发作后5小时，但在美国仅在3小时内。然而，阿替普酶的再通率适中。几项试验显示，缺血性卒中发作后6小时内进行神经血栓切除术具有显著的临床获益，这开启了急性卒中治疗的新时代。随着神经血栓切除术成为标准实践的一部分，将需要更多的试验来确定组织提供这种护理的最佳方式。使用几种类型的先进MRI和CT成像来增强患者选择的持续临床试验正在研究阿替普酶、其他溶栓药物和新型血管内器械，用于卒中发作后的后期。因此，未来临床试验的组织和实施将需要适应从当前一代试验中学到的知识。为急性中风患者提供护理还需要纳入新证实的疗法，并且需要做大量额外的工作来最大限度地提高尽可能多的患者的治疗效果。
For several years, the only therapy with proven efficacy for acute ischaemic stroke was alteplase, which is approved for use within 4. 5 h after stroke onset in many countries, but only within 3 h in the USA. However, the recanalisation rate with alteplase is modest. Several trials have shown substantial clinical benefit of neurothrombectomy within 6 h of ischaemic stroke onset, which has initiated a new era of acute stroke therapy. As neurothrombectomy becomes part of standard practice, additional trials will be needed to determine the best way to organise delivery of this care. Continuing clinical trials with several types of advanced MRI and CT imaging to enhance patient selection are investigating alteplase, other thrombolytic drugs, and novel endovascular devices, for use in later time periods from stroke onset. Consequently, the organisation and implementation of future dinical trials will need to adapt to what has been learned from the present generation of trials. The delivery of care to patients with acute stroke will also need to incorporate newly proven therapies, and much additional work is needed to maximise outcomes in as many patients as possible.