急性缺血性卒中静脉溶栓治疗现状及展望
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摘要
急性缺血性卒中是神经系统的常见病,多发病,其致残率、致死率均很高,严重威胁着人类的健康。所以寻找更有效的治疗方法特别重要,目前溶栓治疗已被大家公认为急性缺血性卒中急救的主要手段,并且一直是人们关注和探讨的热点。文章将对急性缺血性卒中溶栓治疗的理论基础、治疗时窗、溶栓药物、溶栓治疗未来方向等方面进行概述和展望。
Acute ischemic stroke is a common and frequently-occurring disease of the nervous system, with high fatality rate and disability rate, and has a serious threat to human health. So it is particularly important to find more effective treatments. Thrombolytic therapy has been widely recognized as the main emergency treatment for acute ischemic stroke, and has been a hot topic in clinical practice and research. The article will summarize the theoretical basis, treatment time window, thrombolytic drugs and future directions of thrombolytic therapy for acute ischemic stroke.
Acute ischemic stroke is a common and frequently-occurring disease of the nervous system, with high fatality rate and disability rate, and has a serious threat to human health. So it is particularly important to find more effective treatments. Thrombolytic therapy has been widely recognized as the main emergency treatment for acute ischemic stroke, and has been a hot topic in clinical practice and research. The article will summarize the theoretical basis, treatment time window, thrombolytic drugs and future directions of thrombolytic therapy for acute ischemic stroke.
引文
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[2]Baron JC,von Kummer R,del Zoppo GJ.Treatment of acute ischemic stroke:Challenging the concept of a rigid and universal time window[J].Stroke,1995,26(12):2219-2221.
[3]Hacke W,Albers G,Al-Rawi Y,et al.The Desmoteplase in Acute Ischemic Stroke Trial(DIAS):a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase[J].Stroke,2005,36:66-73.
[4]Rowley H.Successful patient selection with DW/PWI MRI for IVtreatment with desmoteplase at 3-9 hours:DIAS and DEDAS trial results.Presented at the American Society of Neuroradiology Meeting.Toronto Ontario Canada 21-27,2005.
[5]Nogueira RG,Jadhav AP,Haussen DC,Bonafe A,et al.Thrombectomy6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct[J].N Engl J Med,2018,378(1):11-21.
[6]Albers GW,Marks MP,Kemp S,et al.Thrombectomy for Stroke at 6 to16 Hours with Selection by Perfusion Imaging[J].N Engl J Med,2018,378(8):708-718.
[7]国家”九五”攻关课题协作组.急性脑梗死六小时以内的静脉溶栓治疗[J].中华神经科杂志,2002,35(4):210-213.
[8]Multicenter Acute Stroke Trial-Europe Study Group,Hommel M,Cornu C,et al.Thrombolytic therapy with streptokinase in acute ischemic stroke[J].N Engl J Med,1996,335(3):145-150.
[9]Furlan A,Higashida R,Wechsler L,et al.Intra-arterial prourokinase for acute ischemic stroke.The PROACT II study:a randomized controlled trial.Prolyse in Acute Cerebral Thromboembolism[J].JAMA,1999,282(21):2003-2011.
[10]The National Institute of Neurological Disorders and Stroke rt-PAStroke Study Group Tissue plasminogen activator for acute ischemic stroke[J].N Engl J Med,1995,333:1581-1587.
[11]Hacke W,Kaste M,Bluhmki E,et al.Thrombolysis with alteplase 3to 4.5 hours after acute ischemic stroke[J].N Engl J Med,2008,359:1317-1329.
[12]Haley EC Jr,Lyden PD,Johnston KC,et al.A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke[J].Stroke,2005,36(3):607-612.
[13]Parsons MW,Miteff F,Bateman GA,et al.Acute ischemic stroke:imaging-guided tenecteplase treatment in an extended time window[J].Neurology,2009,72(10):915-921.
[14]Parsons M,Spratt N,Bivard A,et al.A randomized trial of tenecteplase versus alteplase for acute ischemic stroke[J].N Engl J Med,2012,366(12):1099-1107.
[15]Huang X,Cheripelli BK,Lloyd SM,et al.Alteplase versus tenecteplase for thrombolysis after ischaemic stroke(ATTEST):a phase 2,randomised,open-label,blinded endpoint study[J].Lancet Neurol,2015,14(4):368-376.
[16]Logallo N,Novotny V,Assmus J,et al.,Tenecteplase versus alteplase for management of acute ischaemic stroke(NOR-TEST):a phase 3,randomised,open-label,blinded endpoint trial[J].Lancet Neurol,2017,16(10):781-788.
[17]Perler B.Thrombolytic therapies:the current state of affairs[J].JEndovasc Ther,2005,12(2):224-232.
[18]Grandjena C,McMullen Pc,Newschwander G.Vampire bats yield potent clotbuster for ischemic stroke[J].J Cardiovasc Nurs,2004,19:417-420.
[19]Hacke W,Furlan AJ,Al-Rawi Y,et al.Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusiondiffusion weighted imaging or perfusion CT(DIAS-2):a prospective,randomised,double-blind,placebo-controlled study[J].Lancet Neurol,2009,8(2):141-150.
[20]Albers GW,von Kummer R,Truelsen T,et al.Safety and efficacy of desmoteplase given 3-9 h after ischaemic stroke in patients with occlusion or high-grade stenosis in major cerebral arteries(DIAS-3):a double-blind,randomised,placebo-controlled phase 3 trial[J].Lancet Neurol,2015,14(6):575-84.
[21]Grotta JC,Welch KMA,Fagan SC,et al.Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial[J].Stroke,2001,32(3):661-668.
[22]李金英.抗凝对于预防急性脑梗死溶栓后血管再闭塞的作用[J].实用心脑肺血管病杂志,2012,20(1):2-3.
[23]陈友芹.低分子肝素钙在急性脑梗死患者静脉溶栓后血管再闭塞治疗中的应用价值[J].河南医学研究,2017,26(3):2380-2381.
[24]高峰,徐安定.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015(7):590-606.
[25]Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.
[26]Tsivgoulis G,Eggers J,Ribo M,et al.Safety and efficacy of ultrasoundenhanced thrombolysis:a comprehensive review and meta-analysis of randomized and nonrandomized studies[J].Stroke,2010,41(2):280-287.
[27]Nacu A,Kvistad CE,Naess H,et al.NOR-SASS(Norwegian Sonothrombolysis in Acute Stroke Study):Randomized Controlled Contrast-Enhanced Sonothrombolysis in an Unselected Acute Ischemic Stroke Population[J].Stroke,2017,48(2):335-341.
[28]Zinkstok SM,Roos YB;ARTIS investigators.Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke:a randomised controlled trial[J].Lancet,2012,380(9843):731-737.
[29]Barreto AD,Ford GA,Shen L,et al.Randomized,Multicenter Trial of ARTSS-2(Argatroban With Recombinant Tissue Plasminogen Activator for Acute Stroke)[J].Stroke,2017,48(6):1608-1616.
[2]Baron JC,von Kummer R,del Zoppo GJ.Treatment of acute ischemic stroke:Challenging the concept of a rigid and universal time window[J].Stroke,1995,26(12):2219-2221.
[3]Hacke W,Albers G,Al-Rawi Y,et al.The Desmoteplase in Acute Ischemic Stroke Trial(DIAS):a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase[J].Stroke,2005,36:66-73.
[4]Rowley H.Successful patient selection with DW/PWI MRI for IVtreatment with desmoteplase at 3-9 hours:DIAS and DEDAS trial results.Presented at the American Society of Neuroradiology Meeting.Toronto Ontario Canada 21-27,2005.
[5]Nogueira RG,Jadhav AP,Haussen DC,Bonafe A,et al.Thrombectomy6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct[J].N Engl J Med,2018,378(1):11-21.
[6]Albers GW,Marks MP,Kemp S,et al.Thrombectomy for Stroke at 6 to16 Hours with Selection by Perfusion Imaging[J].N Engl J Med,2018,378(8):708-718.
[7]国家”九五”攻关课题协作组.急性脑梗死六小时以内的静脉溶栓治疗[J].中华神经科杂志,2002,35(4):210-213.
[8]Multicenter Acute Stroke Trial-Europe Study Group,Hommel M,Cornu C,et al.Thrombolytic therapy with streptokinase in acute ischemic stroke[J].N Engl J Med,1996,335(3):145-150.
[9]Furlan A,Higashida R,Wechsler L,et al.Intra-arterial prourokinase for acute ischemic stroke.The PROACT II study:a randomized controlled trial.Prolyse in Acute Cerebral Thromboembolism[J].JAMA,1999,282(21):2003-2011.
[10]The National Institute of Neurological Disorders and Stroke rt-PAStroke Study Group Tissue plasminogen activator for acute ischemic stroke[J].N Engl J Med,1995,333:1581-1587.
[11]Hacke W,Kaste M,Bluhmki E,et al.Thrombolysis with alteplase 3to 4.5 hours after acute ischemic stroke[J].N Engl J Med,2008,359:1317-1329.
[12]Haley EC Jr,Lyden PD,Johnston KC,et al.A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke[J].Stroke,2005,36(3):607-612.
[13]Parsons MW,Miteff F,Bateman GA,et al.Acute ischemic stroke:imaging-guided tenecteplase treatment in an extended time window[J].Neurology,2009,72(10):915-921.
[14]Parsons M,Spratt N,Bivard A,et al.A randomized trial of tenecteplase versus alteplase for acute ischemic stroke[J].N Engl J Med,2012,366(12):1099-1107.
[15]Huang X,Cheripelli BK,Lloyd SM,et al.Alteplase versus tenecteplase for thrombolysis after ischaemic stroke(ATTEST):a phase 2,randomised,open-label,blinded endpoint study[J].Lancet Neurol,2015,14(4):368-376.
[16]Logallo N,Novotny V,Assmus J,et al.,Tenecteplase versus alteplase for management of acute ischaemic stroke(NOR-TEST):a phase 3,randomised,open-label,blinded endpoint trial[J].Lancet Neurol,2017,16(10):781-788.
[17]Perler B.Thrombolytic therapies:the current state of affairs[J].JEndovasc Ther,2005,12(2):224-232.
[18]Grandjena C,McMullen Pc,Newschwander G.Vampire bats yield potent clotbuster for ischemic stroke[J].J Cardiovasc Nurs,2004,19:417-420.
[19]Hacke W,Furlan AJ,Al-Rawi Y,et al.Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusiondiffusion weighted imaging or perfusion CT(DIAS-2):a prospective,randomised,double-blind,placebo-controlled study[J].Lancet Neurol,2009,8(2):141-150.
[20]Albers GW,von Kummer R,Truelsen T,et al.Safety and efficacy of desmoteplase given 3-9 h after ischaemic stroke in patients with occlusion or high-grade stenosis in major cerebral arteries(DIAS-3):a double-blind,randomised,placebo-controlled phase 3 trial[J].Lancet Neurol,2015,14(6):575-84.
[21]Grotta JC,Welch KMA,Fagan SC,et al.Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial[J].Stroke,2001,32(3):661-668.
[22]李金英.抗凝对于预防急性脑梗死溶栓后血管再闭塞的作用[J].实用心脑肺血管病杂志,2012,20(1):2-3.
[23]陈友芹.低分子肝素钙在急性脑梗死患者静脉溶栓后血管再闭塞治疗中的应用价值[J].河南医学研究,2017,26(3):2380-2381.
[24]高峰,徐安定.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015(7):590-606.
[25]Goyal M,Menon BK,van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:a meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.
[26]Tsivgoulis G,Eggers J,Ribo M,et al.Safety and efficacy of ultrasoundenhanced thrombolysis:a comprehensive review and meta-analysis of randomized and nonrandomized studies[J].Stroke,2010,41(2):280-287.
[27]Nacu A,Kvistad CE,Naess H,et al.NOR-SASS(Norwegian Sonothrombolysis in Acute Stroke Study):Randomized Controlled Contrast-Enhanced Sonothrombolysis in an Unselected Acute Ischemic Stroke Population[J].Stroke,2017,48(2):335-341.
[28]Zinkstok SM,Roos YB;ARTIS investigators.Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke:a randomised controlled trial[J].Lancet,2012,380(9843):731-737.
[29]Barreto AD,Ford GA,Shen L,et al.Randomized,Multicenter Trial of ARTSS-2(Argatroban With Recombinant Tissue Plasminogen Activator for Acute Stroke)[J].Stroke,2017,48(6):1608-1616.