大核心缺血性脑卒中机械取栓现状及相关研究进展  

Current status and related research progress of mechanical thrombectomy in large core ischemic stroke of anterior circulation

作　　者：蒋文贤 王树青[1] 唐文成[1] 胡启洋 肖榕 康玉卓 周义杰[1] JIANG Wenxian;WANG Shuqing;TANG Wenchen;HU Qiyang;XIAO Rong;KANG Yuzhuo;ZHOU Yijie(Guilin Municipal Hospital of Traditional Chinese Medicine,Guilin,Guangxi Zhuang Autonomous Region 541002,China)

机构地区：[1]桂林市中医医院,广西桂林541002

出　　处：《介入放射学杂志》2023年第12期1256-1262,共7页Journal of Interventional Radiology

基　　金：广西科技计划项目(桂科AD20238028)。

摘　　要：机械取栓是近年来急性脑梗死治疗的最重要研究进展,特别是在2015年五大血管内治疗研究的阳性结果改写了临床指南,但是其研究的重点主要针对小核心脑梗死患者(small vessel infarction,SVI),其入选标准:ASPECTS≥6分,Alberta卒中项目早期CT评分(Alberta Stroke Program Early CT Score)卒中发作6 h内;卒中发作6~24 h内,梗死体积小于70 mL,且存在影像错配或存在临床与灌注影像不匹配。上述研究均排除了大核心脑梗死(large core infarction,LCI)ASPECTS<6分或梗死体积≥70 mL的患者,而随着急性缺血性脑卒中(acute ischemic stroke,AIS)血管内治疗研究的不断进展,机械取栓从“时间窗”跨向“组织窗”,同时也从小核心脑梗死跨向了最近非常热门的大核心梗死时代。对于大核心梗死患者血管内治疗是否有益,目前仍不确定。本文主要针对前循环大核心缺血性脑卒中血管内治疗的相关研究进展进行综述,比如大核心脑梗死影像判定及研究入选标准、术后血压管理、无效再通及预后影响因素等。In recent years,mechanical thrombectomy has been the most important research progress in the treatment of acute cerebral infarction,especially the positive results of five endovascular therapy studies in 2015 has rewritten its clinical guidelines.However,the focus of these studies was mainly on the small vessel infarction(SVI),and the inclusion criteria of these studies include the following aspects:ASPECTS≥6 points,Alberta Stroke Program Early CT Score within 6 hours after stroke onset,the infarct volume<70 mL within 6-24 hours after stroke onset,and the presence of image mismatch or the presence of mismatch between clinical condition and perfusion imaging.The above studies excluded patients with ASPECTS<6 points or infarct volume≥70 mL of large core infarction(LCI).With the continuous progress of the endovascular treatment of acute ischemic stroke(AIS),the mechanical thrombectomy therapy strategy has crossed from the“time window”to the“tissue window”,meanwhile,the therapeutic goal of mechanical thrombectomy has also moved from treating SVI to a new era of treating LCI that has been a very hot topic recently.Whether endovascular treatment is beneficial for patients with LCI remains uncertain.This paper aims to make a comprehensive review concerning the relevant research progress in endovascular therapy for anterior circulation large core ischemic stroke,including the imaging determination and study inclusion criteria of LCI,the postoperative blood pressure management,and the factors influencing ineffective recanalization and prognosis.

关 键 词：大核心脑梗死 小核心脑梗死 机械取栓 

分 类 号：R743.7[医药卫生—神经病学与精神病学]