Management of Acute Ischemic Stroke
Management of Acute Ischemic Stroke
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DOI：
10.1055/s-0039-1692831
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发表时间：
2019-03
影响因子：
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通讯作者：
Ponniah Vanamoorthy;Kavu Samy;P. Bidkar
中科院分区：
文献类型：
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作者：
Ponniah Vanamoorthy;Kavu Samy;P. Bidkar
摘要 急性缺血性脑卒中（AIS）是一种时间敏感的神经急症，它仍然是最常见的脑卒中类型。快速神经影像学是在 AIS 治疗中启动时间敏感干预措施的基石。曾经被认为不可逆的血运重建疗法，包括静脉溶栓 (IVT) 和血管内治疗 (EVT)，及时进行，已经彻底改变了 AIS 的治疗。这些疗法的适应症在过去几年中不断扩大，并且每年都在取得许多进展。 IVT 向所有符合条件的患者提供，在症状出现后 3 小时内就诊，并符合附加标准，最多 4.5 小时内就诊。使用支架回收器或抽吸装置的 EVT 曾经仅限于中风发作的前 6 小时，现在可提供长达 24 小时的服务，并具有先进的图像引导患者选择，其中包括计算机断层扫描或磁共振灌注成像。从院前护理开始的基于方案的中风管理方法可以减少治疗开始的时间延迟。通过创建护理系统、医院中风团队和“中风代码”来提供这些治疗的机会，可以改善 AIS 患者的预后。
Abstract Acute ischemic stroke (AIS) is a time-sensitive neurological emergency and it remains to be the most common type of stroke. Rapid neuroimaging is the cornerstone for initiating time-sensitive interventions in the treatment of AIS. Revascularization therapies that were once considered irreversible, including intravenous thrombolysis (IVT) and endovascular treatment (EVT), administered in a timely fashion have revolutionized the treatment of AIS. The indications for these therapies have expanded over the past few years and a lot of advancements are happening every year. IVT is offered to all eligible patients presenting within 3 hours of symptom onset and up to 4.5 hours with additional criteria. EVT with stent retrievers or aspiration devices, once limited to the first 6 hours of stroke onset, is now being offered up to 24 hours with advanced image-guided patient selection, which includes a computed tomography or magnetic resonance perfusion imaging. A protocol-based approach to the management of stroke, beginning from prehospital care reduces the time delay in the initiation of treatment. Providing access to these therapies by creating systems of care, hospital stroke team, and “stroke codes” improves the outcome of patients with AIS.