Expanding the window for thrombolytic therapy in acute stroke - The potential role of acute MRI for patient selection
Expanding the window for thrombolytic therapy in acute stroke - The potential role of acute MRI for patient selection
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DOI：
10.1161/01.str.30.10.2230
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发表时间：
1999-10-01
期刊：
影响因子：
8.3
通讯作者：
Albers, GW
中科院分区：
文献类型：
--
作者：
Albers, GW
背景-直到 1995 年，急性中风的有效治疗才出现，当时组织纤溶酶原激活剂 (tPA) 被证明可以改善中风患者的神经和功能结果，这些患者在症状发作后 3 小时内创建。审查摘要-目前，许多患者不符合 tPA 治疗的条件，因为他们在中风发作后 3 小时后才进行评估。尝试将治疗窗口扩大到 6 小时，使用 CT 来选择患者，但都失败了。在识别可能受益于溶栓治疗的患者方面，早期 MR 成像的使用可能比 CT 具有显着优势，因为 (1) 早期灌注加权成像 (PWI) 病变可估计急性功能障碍脑组织的区域，而急性弥散加权成像 (DWI) 病变似乎对应于早期梗塞的核心； (2) 急性 PWI 病变和较小的 DWI 病变之间的不匹配代表潜在可挽救的脑组织（缺血半暗带的估计）； (3) 在 PWI/DWI 不匹配的患者中，早期再灌注通常与显着的临床改善以及 DWI 病变生长的逆转或减少有关。结论 - 使用新 MRI 技术筛选患者的临床试验可能能够识别出一部分急性卒中患者，即使在卒中发生后 3 小时后，他们也是溶栓治疗的理想候选者。
Background-Effective therapy was not available for treatment of acute stroke until 1995, when tissue plasminogen activator (tPA) was shown to improve neurological and functional outcome in stroke patients who were Created within 3 hours of symptom onset.Summary of Review-Currently, many patients do not qualify for tPA therapy because they present for evaluation beyond 3 hours after stroke onset. Attempts to expand the treatment window to 6 hours, using CT to select patients, have failed. Use of early MR imaging may provide significant advantages over CT for identification of patients who are likely to benefit from thrombolytic therapy because (1) the early perfusion-weighted imaging (PWI) lesion estimates the region of acute dysfunctional brain tissue, whereas the acute diffusion-weighted imaging (DWI) lesion appears to correspond to the core of the early infarction; (2) the mismatch between the acute PWI lesion and the smaller DWI lesion represents potentially salvageable brain tissue (an estimate of the ischemic penumbra); and (3) in patients with a PWI/DWI mismatch, early reperfusion is often associated with substantial clinical improvement and reversal or reduction of DWI lesion growth.Conclusions-Clinical trials that use new MRI techniques to screen patients may be able to identify a subset of acute stroke patients who are ideal candidates for thrombolytic therapy even beyond 3 hours after stroke onset.