血管内治疗时代急性缺血性卒中的神经保护治疗

Neuroprotective therapy for acute ischemic stroke in the era of endovascular therapy

近年来,血管内治疗成为大血管闭塞所致急性缺血性卒中治疗领域的最重要进展。然而,尽管经过积极的血管内治疗,但影像学所示的血管再通并不能完全转化为有效的组织再灌注和功能转归,这种现象称为"无效再通"。血管再通后联合神经保护治疗有望减少无效再通的发生并改善患者转归。文章对临床常用的神经保护治疗(依达拉奉右莰醇、糖皮质激素、低温及远隔缺血适应)的主要应用进展进行简要总结,探讨对大血管闭塞所致急性缺血性卒中患者联合应用血管内治疗和神经保护治疗的趋势和方向,为血管内治疗后的干预措施提供进一步的参考和建议。

In recent years,endovascular therapy has become the most important progress in the field of the treatment of acute ischemic stroke caused by large vessel occlusion.However,the vascular recanalization shown by imaging after endovascular treatment cannot fully translate into effective tissue reperfusion and functional outcome,a phenomenon known as"futile recanalization".Combined neuroprotective therapy after vascular recanalization is expected to reduce the occurrence of futile recanalization and improve the outcome of patients.This article briefly summarizes the main application progress of commonly used neuroprotective therapies in clinical practice(edaravone dexborneol,glucocorticoids,hypothermia,and remote ischemic conditioning).It explores the trend and direction of combining endovascular therapy and neuroprotective therapy for patients with acute ischemic stroke caused by large vessel occlusion,and provides further reference and suggestions for intervention measures after endovascular therapy.