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取栓术前溶栓治疗——溶栓还是相信DIRECT-MT
Thrombolysis before Thrombectomy — To Be or DIRECT-MT?


Gregory W. Albers ... 心脑血管疾病 • 2020.05.21
相关阅读
• 缺血性卒中血栓切除术前使用替奈普酶和阿替普酶的比较 • 血管内取栓术联合和不联合阿替普酶静脉溶栓治疗急性缺血性卒中的比较研究

研究证明,对于经过适当选择的症状发作后24小时内的急性缺血性卒中患者,血管内取栓术是安全而有效的1-3。多项研究试图扩大取栓术的适应证,以期更多的患者能从取栓术获益,并且努力改善这种治疗方法。阿替普酶是一种静脉溶栓药物,可有效治疗缺血性卒中,但尚不明确的一个重要问题是取栓术前给予阿替普酶的疗效是否优于取栓术前不给予阿替普酶。

阿替普酶和取栓术联合应用的潜在优势在于该治疗策略有可能使闭塞血管的再通更早、更完全,特别是取栓术延迟或机械取栓装置难以触及血栓的病例更是如此。其他可能的价值包括阿替普酶可将血管内手术期间移向远端血管的血栓碎片溶解,并且可在介入手术开始前使血管再通。但另一方面,静脉注射溶栓药可能会延误血管内手术并增加出血的风险和费用。





作者信息

Gregory W. Albers, M.D.
From the Stanford Stroke Center, Palo Alto, CA.

 

参考文献

1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723-1731.

2. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21.

3. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708-718.

4. Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 2020;382:1981-1993.

5. Wang Y, Zhao X, Liu L, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke 2014;45:663-669.

6. Non-inferiority for direct mechanical thrombectomy “could not be proven.” NeuroNews. February 24, 2020 (https://neuronewsinternational.com/thrombectomy-without-iv-thrombolysis/. opens in new tab).

7. Campbell BCV, Mitchell PJ, Churilov L, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med 2018;378:1573-1582.

8. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50(12):e344-e418.

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