应重视急性缺血性卒中患者无效再通管理

Pay attention to the futile recanalization management of patients with acute ischemic stroke

血管开通治疗是目前被广泛证实急性缺血性卒中有效的治疗方法之一。近年来,越来越多的血管内取栓治疗临床研究结果得到公布及推广,大大改善了这类患者的神经功能。但研究数据及临床实践发现,尽管大血管成功再通[公认的评估改良脑梗死溶栓(mTICI)分级在2b/3级以上],仍有近一半的患者临床结局不良,称为“无效再通”。相关原因及机制复杂,可能与侧支血管代偿不良、微血栓形成、远端小血管再闭塞等有关。其中最重要的病理生理改变是虽然大血管开通,但脑组织的灌注不良,即“无复流现象”。要关注血管开通并发症的管理,如出血转化、高灌注综合征、血管再闭塞甚至手术相关并发症(动脉夹层、造影剂诱导性脑病)等,未来研究应更加注重具有多靶点保护作用的药物联合血管开通治疗策略。本期重点号围绕这个问题组织了相关的原创性研究和综述进行分享,目的是提出临床问题,希望同行关注“无效再通”,探讨相关机制及未来的预测干预策略,为进一步改善急性卒中患者预后提供更多的选择。

Vascular recanalization therapy has been proven to be one of the most effective treatments for acute ischemic stroke(AIS)worldwide.Recently,the neurological functions have dramatically improved for AIS patients receiving endovascular thrombectomy,especially after the issue and promotion of evidence from different clinical studies.But nearly 50%of the patients had unfavorable clinical outcome even after successful recanalization[modified thrombolysis in cerebral infarction(mTICI)≥2b/3],which was termed as"futile recanalization".The mechanisms are complex,which may be related to poor collateral circulation,microthrombus and small artery reocclusion.The most significant pathophysiological change is brain tissue hypoperfusion although complete opening of the large artery,known as"no‑reflow phenomenon".Therefore,it is urgent to manage the complications after vascular recanalization,such as hemorrhagic transformation,hyperperfusion syndrome,vascular re‑occlusion,and even surgery‑related complications(arterial dissection,contrast‑induced encephalopathy),and future research is warranted to focus on the strategy of drugs with multi‑target protection combined with vascular recanalization treatment.The current article covers the review,original research and case report focusing on this topic,aiming to raise clinical questions and call for more contribution to explore the mechanism and potential therapeutic strategy of futile recanalization,and thus provides more selections on the improvement of clinical outcome for AIS patients.