暂时性缺血性发作和急性缺血性中风的诊断和治疗:一篇评论
Scott J Mendelson1, Shyam Prabhakaran1,2
1Department of Neurology, University of Chicago, Chicago, Illinois.
JAMA
|March 16, 2021
概括
早期的双重抗血小板治疗可降低高风险的短暂性缺血性发作 (TIA) 和轻微性中风的风险. 在致残的急性缺血性中风 (AIS) 中,及时进行血栓溶解和机械血栓切除可显著改善功能结果.
科学领域:
- 神经学
- 心血管医学
- 公共卫生
背景情况:
- 在美国,中风是导致死亡和残疾的主要原因, 每年有近80万人受到影响.
- 急性缺血性中风 (AIS) 和过渡性缺血性中风 (TIA) 是不同的脑血管事件,具有不同的短期中风风险.
- 识别高风险患者和及时实施干预措施对于减少中风发生率和改善结果至关重要.
研究的目的:
- 为急性缺血性中风 (AIS) 和短暂缺血性发作 (TIA) 制定基于证据的治疗指南.
- 总结双抗血小板治疗在TIA或轻微AIS后预防中风的疗效.
- 审查再注血疗法的好处,包括IV高血和机械血栓切除,以禁用AIS.
主要方法:
- 对TIA和AIS的临床研究和治疗指南的审查.
- 对双重抗血小板治疗 (阿司匹林和克洛皮多格勒) 疗效的数据分析.
- 在AIS患者中评估与静脉复合组织等离子体激活剂 (IVrtPA) 和机械血栓切除相关的结果.
主要成果:
- 在某些高风险的TIA和轻微的AIS患者中,三周的双重抗血小板治疗降低了中风风险 (7. 8%至5. 2%).
- 在症状发作后4. 5小时内,IVrtPA可改善功能结局,使AIS失效.
- 在6-24小时内进行机械血栓切除可显著提高功能独立性,使大血管封闭症的AIS失效.
结论:
- 在24小时内启动双抗血小板治疗对于特定的TIA和轻微的中风患者是有效的.
- 血栓溶解和机械血栓切除是改善AIS功能结果的关键干预措施.
- 及时和适当的治疗策略对于减轻中风的影响至关重要.
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