急性缺血性卒中机械血栓切除术前有必要静脉溶栓吗?

Is intravenous thrombolysis necessary before mechanical thrombectomy for acute ischemic stroke?

大血管闭塞性卒中(acute ischemic stroke with large vessel occlusion,AIS-LVO)是指颈内动脉、大脑中动脉和椎基底动脉等大血管闭塞导致的缺血性卒中,具有梗死灶大、转归相对较差以及致残率和致死率较高的特点。因此,早期血管再通并挽救缺血半暗带是改善AIS-LVO患者转归的关键。机械血栓切除术(mechanical thrombotomy,MT)对AIS-LVO疗效确切,目前指南推荐,对于无静脉溶栓(intravenous thrombolysis,IVT)禁忌证的AIS-LVO患者,需在IVT基础上进行MT,即所谓的桥接治疗。IVT可在一定程度上增高出血风险,延误MT,并增加住院费用。不过,AIS-LVO患者能否直接进行MT尚存在较多争议。文章就前循环AIS-LVO患者直接MT与桥接治疗的对比研究进行了综述,期望就AIS-LVO的治疗为临床医生提供参考。

Acute ischemic stroke with large vessel occlusion(AIS-LVO)refers to ischemic stroke caused by large vessel occlusion of internal carotid artery,middle cerebral artery and vertebrobasilar artery,which has the characteristics of large infarct,relatively poor outcome,higher disability and mortality.Therefore,early vascular recanalization and rescue of ischemic penumbra are the key to improve the outcome of patients with AIS-LVO.Mechanical thrombectomy(MT)has a definite effect on AIS-LVO.The current guidelines recommend that MT should be performed on the basis of IVT for AIS-LVO patients without contraindications of intravenous thrombolysis(IVT),the so-called bridging therapy.IVT can increase the risk of bleeding to a certain extent,delay MT and increase the cost of hospitalization.However,there are still many controversies about whether the patients with AIS-LVO can directly perform MT.This article reviews the comparative study of direct MT and bridging therapy in patients with anterior circulation AIS-LVO,hoping to provide reference for clinicians in the treatment of AIS-LVO.