[临床医学]急性缺血性中风与血管内治疗.pdfVIP

急性缺血性中风与血管内治疗 急性缺血性中风的治疗中最有效的无疑是再灌流，而时间窗瓶颈是最大的障碍。与自身相关的再灌流包括血栓自融和侧枝灌 注，治疗性措施包括： 1 动静脉溶栓 2 机械取栓 3 PTA/+STENTING 4 增加灌注压如（Neuroflo-FDA has approved a humanitarian device exemption for an aortic catheter--NeuroFlo, all owing its use for the treatment of cerebral ischemia in acute vasospasm) 5 其它作用于血栓机制的药物 6 广义的讲还应该包括高压氧 Neuroendovascular devices and procedures for acute stroke Thrombectomy MERCI Concentric Retriever Angiojet (Possis Medical, Minneapolis, MN) Neurojet (Possis Medical, Minneapolis, MN) Neuronet (Guidant, Indianapolis, IN) InTime Retriever (Boston Scientific, Natick, MA) Ensnare (MD Tech, Gainesville FL) Suction thrombectomy Thrombolysis Intra-arterial urokinase and tissue plasminogen activator Intra-arterial Reo Pro Balloon angioplasty Laser: LaTis (LaTis, Coon Rapids, MN) and EPAR (endoVasix, Belmont, CA) devices Microguidewire Augmented thrombolysis Intra-arterial ultrasound: MicroLysUS catheter (EKOS, Bothwell, WA) Intra-arterialultrasound: MicroLysUS catheter (EK OS,Bothwell, WA) /cgi/content/full/27/4/728?maxtoshow=HITS=10hits=10RESULTFORMAT=searchid=1FIRSTIN DEX=10minscore=5000resourcetype=HWCIT 无论何种措施都受制于时间窗（包括生理意义上的时间窗），因而具有不同的适应症。但是存在的东西肯定具有其意义，至 少在“证据”出现之前给我们思路已启迪，也正是如此，个体化治疗才具有无穷的魅力，而不是让电脑生产出菜单。 从以上几点来看，血管内治疗涉及到各个环节，让我们来了解一下： 关于动静脉溶栓之争应该是compare apple with apple才有意义。静脉溶栓失败后再动脉溶栓是否安全？先看这篇文章： Is Intra-Arterial Thrombolysis Safe After Full-Dose Intravenous Recombinant Tissue Pasminogen Activator for Acute Ischemic Stroke? Hashem M. Shaltoni, MD; Karen C. Albright, DO, MPH; Nicole R. Gonzales, MD; Raymond U. Weir, MD; Aslam M. Khaja, MD; Rebecca M. Sugg, MD; Morgan S. Campbell, III, MD; Edwin D. Cacayorin, MD; James C