急性颅内大血管闭塞血运重建: 直接还是桥接取栓？——研究回顾及展望

杨清武; 资文杰

doi:10.16016/j.1000-5404.202104153

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急性颅内大血管闭塞血运重建: 直接还是桥接取栓？——研究回顾及展望

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- 急性颅内大血管闭塞血运重建: 直接还是桥接取栓？——研究回顾及展望
- Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?
- 第三军医大学学报 2021年43卷第14期页码：1299-1303
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院神经内科
- 作者简介：
  
  [ 杨清武，博士，主任医师，教授，博士研究生导师，陆军军医大学第二附属医院神经医学中心主任。教育部“长江学者”特聘教授，国家万人计划科技创新领军人才，全军高层次创新人才工程拔尖人才，国务院特殊津贴获得者。担任中华医学会神经病学分会委员，重庆市卒中学会会长。主持国家自然科学基金重大项目、国家自然科学基金重点项目、国家杰出青年科学基金、国家973课题、军队重大研究课题等20余项。培养博士后、博士、硕士研究生50余名。担任Translation Stroke Research、Frontier in Neuroscience、Stroke Vascular Neurology等杂志副主编和编委。以通信作者在JAMA、JAMA Neurol、Ann Neurol、Prog Neurobiol、Circulation、Stroke、J Immunol、JCBFM等SCI收录期刊发表论文60余篇。主要从事急性脑血管病防治的基础与临床转化方面的研究。E-mail: yangqwmlys@163.com YANG Qingwu, E-mail: yangqwmlys@163.com
  资文杰, 博士后, 副主任医师, 主要从事缺血性脑卒中的基础与临床方面的研究。E-mail: ziwenjie1981@163.com
- 基金信息：
  
  国家自然科学基金重大项目(82090040);国家自然科学基金面上项目(81071323)
- DOI：10.16016/j.1000-5404.202104153
  中图分类号： R743.33
- 收稿：2021-04-22，
  
  修回：2021-05-16，
  
  纸质出版：2021-07-30
- 稿件说明：
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杨清武, 资文杰. 急性颅内大血管闭塞血运重建: 直接还是桥接取栓？——研究回顾及展望[J]. 第三军医大学学报, 2021,43(14):1299-1303.

Qingwu YANG, Wenjie ZI. Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?[J]. Journal of Third Military Medical University, 2021, 43(14): 1299-1303.
杨清武, 资文杰. 急性颅内大血管闭塞血运重建: 直接还是桥接取栓？——研究回顾及展望[J]. 第三军医大学学报, 2021,43(14):1299-1303. DOI： 10.16016/j.1000-5404.202104153.

Qingwu YANG, Wenjie ZI. Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?[J]. Journal of Third Military Medical University, 2021, 43(14): 1299-1303. DOI： 10.16016/j.1000-5404.202104153.

摘要

急性缺血性卒中早期管理指南推荐静脉溶栓桥接血管内治疗作为发病4.5 h内急性大血管闭塞致缺血性卒中的首选治疗方法。然而，血管内治疗前的阿替普酶静脉溶栓治疗是一把双刃剑，既可带来获益也可增加风险。是否可以跨过静脉溶栓，直接进行血管内治疗是目前卒中领域研究的焦点。已结束的4项针对发病4.5 h内急性大血管闭塞比较直接血管内治疗与静脉溶栓桥接血管内治疗有效性及安全性的多中心随机对照试验结果表明，直接血管内治疗组功能独立比例与静脉溶栓桥接血管内治疗组接近，两种治疗策略的症状性脑出血发生率及病死率差异无统计学意义。直接血管内治疗可能作为发病4.5 h内急性颅内大血管闭塞患者的新选择。

Abstract

Guidelines for the early management of acute ischemic stroke recommend intravenous thrombolysis followed by endovascular treatment as the first choice for the treatment of stroke with large vessel occlusion within 4.5 h of symptom onset. However

intravenous thrombolysis before endovascular treatment is a double-edged sword

which can not only bring benefits

but also increase risks. Currently

whether it is reasonable to omit intravenous thrombolysis and directly perform endovascular treatment is one of the most controversial issue. Four randomized

controlled

multicenter trial of direct endovascular treatment versus standard bridging therapy for acute stroke patients with large vessel occlusion in the anterior circulation demonstrated that the functional independence rate of the direct endovascular treatment group is similar to that of the intravenous thrombolysis followed by endovascular treatment group

and no significant difference was observed in the incidence of symptomatic intracerebral hemorrhage and mortality between the 2 treatment groups. Direct endovascular treatment may be used as a new option for patients with acute large vessel occlusion within 4.5 h of stroke onset.

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Keywords

references

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