跨越静脉途径治疗急性缺血性脑卒中——直接动脉取栓是否可行?

Skip intravenous thrombolysis―is direct intra-artery thrombectomy feasible for acute ischemic stroke?

脑卒中是我国国民的第一死因,新发病例中缺血性脑卒中占所有脑卒中的70%,急性缺血性脑卒中的救治水平与我国国民的健康密切相关。目前研究已经证实了桥接治疗前循环大血管闭塞急性缺血性脑卒中的安全性及有效性,而单纯静脉溶栓和桥接治疗的症状性颅内出血发生率无明显差异。这是否提示发生这类并发症的主要原因是静脉溶栓而非动脉取栓?因此,能否跨越静脉途径而直接进行动脉取栓是目前临床研究的热点问题。本文将对这一问题进行深入分析。

Stroke is the first cause of death in China,and ischemic stroke is the most common stroke and accounts for 70%of all new stroke cases.The treatment efficiency of acute ischemic stroke is closely related to the health of people in China.Bridging therapy has been proven safe and effective for acute ischemic stroke with anterior circulation large vessel occlusion.The incidence of symptomatic intracerebral hemorrhage is similar in the patients with bridging therapy and intravenous thrombolysis,suggesting that the complication is not due to intra-artery thrombectomy,but rather to intravenous thrombolysis.Thus it has become a research focus whether direct intra-artery thrombectomy is feasible for acute ischemic stroke,skipping intravenous thrombolysis.This paper discusses the related issues.