缺血性脑卒中静脉溶栓进展PPT课件.ppt

Company name 2013美国静脉溶栓指南更新-IV thrombolysis The indication and contraindications are the same for 3 hour and 3-4.5 hour window except: Age 80. Severe stroke NIHSS 25. Taking oral anticoagulant regardless INR. History of DM and prior stroke. THANK YOU SUCCESS * * 可编辑 Company name IA Thrombolysis (I) Class I recommendation Intra-arterial thrombolysis is an option for patients who have major stroke 6 hours durations due to the occlusion of MCA, otherwise not candidate for IV rtPA (Class I, Level of Evidence B). Treatment requires the patients to be at an experienced stroke center with immediate access to cerebral angiography and qualified interventionalists. The dosage is not established and the procedure has not been approved by FDA (Revised-NEW) . Company name IA Thrombolysis (II) Class II recommendation: IA thrombolysis is reasonable in patients who have contraindication for IV thrombolysis, such as recent surgery (Class IIa, Level of Evidence C) Class III recommendation: The availability of IA thrombolysis should not generally preclude the IV rtPA in otherwise eligible patients (Class III, Evidence C) Company name Endovascular Interventions There are 4 FDA approved devices: Merci Retrieval System (2004), Penumbra System (2007), Solitaire Flow Restoration Device (2012), and Trevo Retriever (2012). Regarding the effectiveness: Solitaire FR device and Trevo Retriever are better the Merci System (Class I, Evidence A, NEW) Company name 静脉溶栓的安全性评价 溶栓的绝对禁忌症 溶栓前评价 影响溶栓后病情进展的因素 溶栓后可能发生出血的临床及影像评价 溶栓后出血的治疗 Company name 溶栓的绝对禁忌症 不是卒中（低血糖、肿瘤） CT显示出血 大面积脑梗死（ASPECT7分；DWI70ml） 活动性大出血 近期不能压迫部位的外科手术 抗凝达标（INR=2-3） Company name 急性缺血性脑卒中溶栓前评价 时间窗 是否溶栓绝对禁忌症 脑缺血的靶血管情况（MRA） 核心坏死区范围大小（DWI） 濒死的组织大小（PWI/DWI/NIHSS） 侧枝循环情况 是否存在影响血管开通后的全身或局部风险 患者及家属的价值取向 Company name 影响溶栓后症状波动或加重的因素 Company name 溶栓后出血的定义及分类 溶栓后出血分类：无症状性，症状性 症状性出血的定义： --NINDS定义：出血伴治疗后36小时内NIHSS恶化≥1 --ECASS定义：治疗后出现的任何一种颅内出血，且NIHSS较基线或7天内的最低值恶化≥4，或导致死亡。 --SITS-MOST定义：治疗后22-36小时内，P