静脉溶栓桥接与直接机械取栓治疗急性缺血性卒中的比较

Bridging with intravenous thrombolysis versus direct endovascular thrombectomy for acute ischemic stroke

急性缺血性卒中致残率和致死率都很高，给家庭和社会造成很大负担，及时有效的血管再通治疗有可能使患者获得良好的预后。从2008年开始，在时间窗内对急性缺血性卒中患者进行静脉溶栓治疗成为各国指南的推荐治疗方案。然而，静脉溶栓具有血管再通率较低、治疗时间窗狭窄和禁忌证相对较多等弊端，从而限制了其临床应用。近年来，随着支架样取栓装置的出现，在时间窗内进行机械取栓逐渐成为急性缺血性卒中的主流治疗方案。最新的卒中治疗指南推荐在时间窗内采用静脉溶栓桥接血管内血栓切除术的治疗方法。不过，在取栓前进行静脉溶栓是否会增高血管再通率、改善临床转归以及增高颅内出血风险等问题目前尚无定论。文章对桥接治疗与直接机械取栓的血管再通率、临床转归以及颅内出血风险进行了综述。

The disability and mortality of acute ischemic stroke are very high, which brings great burden to family and society. Timely and effective vascular recanalization is possible to make a good prognosis for patients. Since 2008, the intravenous thrombolytie therapy for patients with acute ischemic stroke within the time window has become the recommended treatment scheme of the guidelines in different countries. However, intravenous thrombolysis has the disadvantages of low vascular recanalization rate, narrow treatment time window, and relatively more contraindications, which limits its clinical application. In recent years, with the appearance of stent-like thrombectomy devices, mechanical thrombectomy within the time window has gradually become the mainstream treatment scheme for acute ischemic stroke. The latest guidelines for stroke treatment recommend the use of intravenous thrombolytic bridging endovascular thrombectomy within the time window. However, it is still unclear whether intravenous thrombolysis will increase the rate of vascular recanalization, improve clinical outcome, and increase the risk of intracranial hemorrhage before thrombectomy. This article reviews the vascular recanalization rate, clinical outcome, and intracranial hemorrhage risk of bridging therapy and direct mechanical thrombectomy.