聚焦脑缺血再灌注时代的神经保护:新的挑战和策略

Refocusing neuroprotection in cerebral reperfusion era: new challenges and strategies

血管内治疗技术的发展开启了急性脑梗死救治的新纪元。然而,临床实践表明,尽管血管内治疗可有效改善部分患者预后,但较低的临床获益比例与较高的血管再通率显著不匹配,这可能与缺血再灌注损伤及再灌注后的神经保护缺失有关。针对当前尚无有效神经保护剂的临床困境及血管内治疗对神经保护提出的新要求,本综述结合神经保护研究现况与临床研究进展,提出急性脑梗死血管内治疗时代神经保护的潜在研究方向:(1)进行多靶点联合治疗(鸡尾酒疗法);(2)将研究重点转向建立有效血流灌注、增加功能性侧枝循环和阐明脑血屏障损伤机制以减少脑梗死后出血转化等。以血管再通为基础,建立血管内治疗前、后的综合神经保护体系可能是进一步改善急性脑梗死患者预后的有效途径。

Development of endovascular therapy opens up a new era in the treatment of acute cerebral infarction.However,clinical practice has shown that although endovascular treatment is effective in improving the prognosis of some patients,the lower percentage of clinical benefit is significantly mismatched with the higher rate of revascularization,this may be related to ischemia-reperfusion injury and the lack of neuroprotection after reperfusion.In response to the current clinical dilemma of no effective neuroprotective agent and the new requirements for neuroprotection from endovascular therapy,this review combines the current status of neuroprotection research with clinical research advances to propose potential research directions for neuroprotection in the era of endovascular treatment of acute cerebral infarction:(1)Perform multi-targeted combination therapy(cocktail therapy),(2)Shift the research focus to establishing recirculation,increasing functional collateral circulation and elucidating the mechanisms of cerebral blood barrier damage to reduce hemorrhagic transformation after cerebral infarction.Based on revascularization,the establishment of an integrated neuroprotection system before and after endovascular treatment may be an effective way to further improve the prognosis of patients with acute cerebral infarction.