重视急性缺血性卒中血管开通后的无效再通

Attention should be paid to futile recanalization after endovascular treatment in acute ischemic stroke

近年来,由于临床研究证据和临床经验的积累,越来越多的急性卒中患者从血管开通治疗中获益,但同时存在“无效再通”现象,即血管成功开通,但神经功能并不恢复。相比于血管成功开通,成功的再灌注可以更准确地预测患者最终梗死体积及临床结局。目前已知有关无效再通的影响因素主要包括高龄、女性、较高的基线美国国立卫生研究院卒中量表(NIHSS)评分、高血压、糖尿病、心房纤颤等因素,以及再灌注治疗策略,大梗死核心体积以及侧支循环状态。我国卒中人群无效再通的发生率显著高于西方人群,然而有关其机制及影响因素的研究仍较少。目前已有许多大型临床研究在抗血小板治疗方案、血压管理、治疗流程改进等方面试图探索减少无效再通的发生,然而仅在血压管理方面发现有效措施:血管成功开通后应避免将收缩压控制在120 mmHg(1 mmHg=0.133 kPa)以下。未来需要在促进侧支循环的建立及维持、联合神经保护治疗等方面进一步探索。

With the accumulation of research evidence and clinical experience,an increasing number of patients benefit from vascular recanalization therapies.Although successful recanalization of the occluded artery has been achieved,neurological deficits persist after endovascular treatment,which defined as"futile reperfusion".Compared with the successful recanalization,successful reperfusion predicts final infarct size and clinical outcome more accurately.At present,the known influencing factors of futile reperfusion include older age,female,high baseline National Institute of Health stroke scale(NIHSS)score,hypertension,diabetes,atrial fibrillation,reperfusion treatment strategy,large infarction core volume,and collateral circulation status.The incidence of futile reperfusion in China is significantly higher than that in western population.However,few studies focused on its mechanism and influencing factors.To date,many clinical studies have attempted to reduce the occurrence of futile recanalization regarding antiplatelet therapy,blood pressure management and treatment process improvement.However,only one effective measure has been achieved in blood pressure management:systolic blood pressure control below 120 mmHg(1 mmHg=0.133 kPa)should be avoided after successful recanalization.Therefore,future studies are warranted to promote the establishment and maintenance of collateral circulation,as well as neuroprotective therapy.