切换至 "中华医学电子期刊资源库"

中华脑血管病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 83 -88. doi: 10.11817/j.issn.1673-9248.2023.02.001

专家论坛

急性缺血性卒中静脉溶栓治疗进展
张运1, 裴月红1, 傅瑜1,()   
  1. 1. 100191 北京大学第三医院神经内科
  • 收稿日期:2023-02-06 出版日期:2023-04-01
  • 通信作者: 傅瑜
  • 基金资助:
    北大医学交叉研究种子基金(BMU2022MX005)

Updates on intravenous thrombolytic therapy of acute ischemic stroke

Yun Zhang1, Yuehong Pei1, Yu Fu1,()   

  1. 1. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-02-06 Published:2023-04-01
  • Corresponding author: Yu Fu
引用本文:

张运, 裴月红, 傅瑜. 急性缺血性卒中静脉溶栓治疗进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 83-88.

Yun Zhang, Yuehong Pei, Yu Fu. Updates on intravenous thrombolytic therapy of acute ischemic stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(02): 83-88.

急性缺血性卒中(AIS)治疗的关键在于尽早开始再灌注治疗,挽救缺血半暗带。重组组织型纤溶酶原激活剂可溶解血液纤维凝块,使闭塞的血管再通,已在诸多国家获得AIS一线治疗药物的批准,并列入了治疗指南。近年来,随着多项相关临床研究成果发布,溶栓治疗应用要点也随着研究的深入而不断更新。本文对AIS的静脉溶栓治疗的卒中绿色通道、超时间窗溶栓、新型溶栓药物、影像学筛查、脑细胞保护等热点问题的研究进展进行综述,希望为临床决策提供参考。

The key to treating acute ischemic stroke (AIS) is to start reperfusion therapy as early as possible to rescue the ischemic penumbra. Recombinant tissue plasminogen activator (rt-PA), which dissolves blood fibrous clots and recanalizes occluded vessels, has been approved as a preferred treatment for AIS in many countries and is included in treatment guidelines. With the publication of several relevant clinical research results, the application of thrombolytic therapy has been updated. This article reviews the research progress of hot issues such as green channel for stroke, broadened therapeutic window, new thrombolytic drugs, imaging screening, and cytoprotection for intravenous thrombolytic therapy of AIS, and hope to provide references for clinical decision-making.

1
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke [J]. N Engl J Med, 1995, 333(24): 1581-1587.
2
Ye Q, Zhai F, Chao B, et al. Rates of intravenous thrombolysis and endovascular therapy for acute ischaemic stroke in China between 2019 and 2020 [J]. Lancet Reg Health West Pac, 2022, 21: 100406.
3
Ebinger M, Siegerink B, Kunz A, et al. Berlin_PRehospital Or Usual Delivery in stroke care (B_PROUD) study group. Association between dispatch of mobile stroke units and functional outcomes among patients with acute ischemic stroke in Berlin [J]. JAMA, 2021, 325(5): 454-466.
4
Grotta JC, Yamal JM, Parker SA, et al. Prospective, multicenter, controlled trial of mobilestroke units [J]. N Engl J Med, 2021, 385(11): 971-981.
5
Kim J, Easton D, Zhao H, et al. Economic evaluation of the Melbourne Mobile Stroke Unit [J]. Int J Stroke, 2021, 16(4): 466-475.
6
Lund UH, Stoinska-Schneider A, Larsen K, et al. Cost-effectiveness of mobile stroke unit care in Norway [J]. Stroke, 2022, 53(10): 3173-3181.
7
国家卫健委脑卒中防治工程委员会专家委员会, 中华医学会急诊分会, 中国卒中学会急救医学分会, 等. 中国5G移动卒中单元院前诊疗管理指南 [J]. 中华神经医学杂志, 2023, 22(1): 2-17.
8
王春娟, 霍晓川, 冀瑞俊, 等. 急性缺血性卒中再灌注治疗医疗质量评价与改进专家建议 [J]. 中国卒中杂志, 2021, 16(7): 705-715.
9
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct [J]. N Engl J Med, 2018, 378(1): 11-21.
10
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging [J]. N Engl J Med, 2018, 378(8): 708-718.
11
Regenhardt RW, González RG, He J, et al. Symmetric CTA collaterals identify patients with slow-progressing stroke likely to benefit from late thrombectomy [J]. Radiology, 2022, 302(2): 400-407.
12
Uniken Venema SM, Dankbaar JW, van der Lugt A, et al. Cerebral collateral circulation in the era of reperfusion therapies for acute ischemic stroke [J]. Stroke, 2022, 53(10): 3222-3234.
13
Olivot JM, Heit JJ, Mazighi M, et al. What predicts poor outcome after successful thrombectomy in early time window? [J]. J Neurointerv Surg, 2022, 14(11): 1051-1055.
14
Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke [J]. N Engl J Med, 2019, 380(19): 1795-1803.
15
Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset [J]. N Engl J Med, 2018, 379(7): 611-622.
16
Tsivgoulis G, Katsanos AH, Malhotra K, et al. Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window [J]. Neurology, 2020, 94(12): e1241-e1248.
17
中华医学会神经病学分会. 中国急性缺血性脑卒中诊治指南2018 [J]. 中华神经科杂志, 2018, 51(9): 666-682.
18
Campbell BCV, Mitchell PJ, Churilov L, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke [J]. N Engl J Med, 2018, 378(17): 1573-1582.
19
Menon BK, Buck BH, Singh N, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial [J]. Lancet, 2022, 400(10347): 161-169.
20
Bivard A, Zhao H, Churilov L, et al. TASTE-A collaborators. Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial [J]. Lancet Neurol, 2022, 21(6): 520-527.
21
Roaldsen MB, Eltoft A, Wilsgaard T, et al. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial [J]. Lancet Neurol, 2023, 22(2): 117-126.
22
Singer OC, Kurre W, Humpich MC, et al. Risk assessment of symptomatic intracerebral hemorrhage after thrombolysis using DWI-ASPECTS [J]. Stroke, 2009, 40(8): 2743-2748.
23
Cheng B, Boutitie F, Nickel A, et al. WAKE-UP (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial) investigators and administrative staff are as follows: quantitative signal intensity in fluid-attenuated inversion recovery and treatment effect in the WAKE-UP Trial [J]. Stroke, 2020, 51(1): 209-215.
24
Hill MD, Goyal M, Menon BK, et al. ESCAPE-NA1 Investigators. Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial [J]. Lancet, 2020, 395(10227): 878-887.
25
Wahlgren N, Thorén M, Höjeberg B, et al. Randomized assessment of imatinib in patients with acute ischemic stroke treated with intravenous thrombolysis [J]. J Intern Med, 2017, 281(3): 273-283.
26
Xu J, Wang A, Meng X, et al. Edaravone dexborneol versus edaravone alone for the treatment of acute ischemic stroke: a phase iii, randomized, double-blind, comparative trial [J]. Stroke, 2021, 52(3): 772-780.
27
Wang M, Feng Y, Yuan Y, et al. Use of l-3-n-Butylphthalide within 24 h after intravenous thrombolysis for acute cerebral infarction [J]. Complement Ther Med, 2020, 52: 102442.
[1] 程飞, 杨辉, 周世玲, 赵航. 静脉溶栓后机械取栓桥接治疗急性大动脉闭塞脑梗死可行性研究[J]. 中华神经创伤外科电子杂志, 2023, 09(03): 149-153.
[2] 朱建华, 刘茜茜, 郑玉琳, 朱水兵. 脑循环治疗仪联合综合康复训练对急性缺血性脑卒中恢复期的效果观察[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(06): 349-354.
[3] 林枫, 张鸿运, 贺迎坤, 李天晓. 围术期NLR变化可预测急性前循环大血管闭塞性卒中取栓患者的临床预后[J]. 中华介入放射学电子杂志, 2022, 10(04): 396-403.
[4] 姚富远, 陈芳兰, 邓哲. 非溶栓急性缺血性卒中患者早期神经功能恶化的影响因素分析[J]. 中华卫生应急电子杂志, 2022, 08(04): 193-198.
[5] 袁兴运, 陈万红, 鱼丽萍, 姚力. 以Wallenberg综合征起病的椎动脉颅外段闭塞介入治疗探讨[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 394-399.
[6] 李昕, 李永凯, 江树青, 夏来百提姑·赛买提, 杨建中. 急性缺血性脑卒中静脉溶栓后出血转化相关危险因素分析[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 331-336.
[7] 王晖, 张淑娟, 周宝华, 杨琼, 罗永梅. 基于卒中单元的缺血性脑卒中静脉溶栓模式的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 150-153.
[8] 俞刘珍雄, 张康睿, 杨若蕊, 刘学春, 王龙, 吴竹青, 吴君仓. 维生素D水平与接受静脉溶栓治疗的缺血性卒中患者预后的关系[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 94-101.
[9] 饶伟, 曹文锋, 项正兵, 刘世民, 周勇良, 文安, 吴凌峰. 丁苯酞氯化钠注射液在急性脑梗死静脉溶栓治疗中的应用研究[J]. 中华脑血管病杂志(电子版), 2023, 17(02): 89-93.
[10] 李昕, 杨建中. 急性缺血性脑卒中静脉溶栓后出血转化危险因素的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(01): 9-15.
[11] 吴小燕, 卢柱标, 陈婷, 余亮, 钟健强, 郭建军. 丁苯酞联合重组组织型纤溶酶原激活剂静脉溶栓治疗对急性缺血性卒中患者预后的影响[J]. 中华脑血管病杂志(电子版), 2022, 16(06): 422-426.
[12] 张晓丽, 韩鑫, 韩坤锜, 李姗姗, 刘相静, 徐东成, 牟磊. 急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓预后相关危险因素分析[J]. 中华脑血管病杂志(电子版), 2022, 16(05): 338-341.
[13] 张开, 周娟, 李玲, 王伟峰. 某县级医院急诊卒中绿色通道在急性缺血性脑卒中静脉溶栓治疗中的作用[J]. 中华脑血管病杂志(电子版), 2022, 16(02): 110-114.
[14] 汤春红, 梁辉, 侯一玮, 于凌, 唐剑华, 于天霞, 巴茂文, 孔敏. 院前通报+院内一体化的溶栓模式对急性缺血性脑卒中患者溶栓的影响[J]. 中华脑血管病杂志(电子版), 2022, 16(02): 100-105.
[15] 季秋虹, 柯开富, 沈俊涛, 徐飞, 张红, 徐添, 刘可威, 高建林, 巢宝华. 开展“中国千县万镇卒中识别行动”后区域脑卒中医疗服务流程改进的研究[J]. 中华脑血管病杂志(电子版), 2022, 16(02): 84-87.
阅读次数
全文


摘要