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MRI引导下阿替普酶静脉给药治疗卒中——仍然卡在时间上
MRI-Guided Intravenous Alteplase for Stroke — Still Stuck in Time


Tudor G. Jovin ... 心脑血管疾病 • 2018.08.16
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• 溶栓治疗轻度卒中的益处尚不清楚 • 急性缺血性卒中的静脉溶栓治疗 • 缺血性卒中快速血管内治疗的随机评估 • 急性缺血性卒中的血管内治疗

时间是急性卒中患者是否适合接受静脉溶栓治疗的关键决定因素。在这些患者中,阿替普酶静脉给药治疗通常在症状出现后4.5小时内进行,但即使在这个时间窗口内,较早治疗也会获得较好的结局。将治疗限制在固定时间具有局限性,因为症状出现时间通常无法确定,特别是在从睡眠中醒来时伴有神经功能缺损的患者中。此外,大多数患者在症状出现后超过4.5小时到达医院,这使得只有少数患者适合接受治疗。症状持续时间是缺血性损害可逆性的粗略替代指标,但更好的指标是缺血组织和梗死组织体积之间的平衡。计算机断层扫描(CT)灌注成像和磁共振成像(MRI)可以合理准确地确定尚未梗死的可挽救性缺血组织的体积与较小体积的固定脑梗死之间是否存在不匹配1,2





作者信息

Tudor G. Jovin, M.D.
From the Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh.

 

参考文献

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