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1、急性缺血性脑卒中血管成形术（英文）Introduction-Thereare700,000ischemicstrokes/yearintheU.S.-70%ofpatientswithcerebralocclusions-Since1995,IVt-PAutilizedwithin0-3hourtimewindow1-Ratesofdelivery3-19%atspecializedcentersvs.1-2%inthecommunity-Othertherapeuticoptionsneededtobenefitlargernumberofpatients1NIND
2、St-PAstudygroup,NEJM1995,2Hackeetal.Lancet2004Intro(Cont’d)Potentialwaystoincreasepatientsbeingtreated:1)Utilizationofperfusionmismatchtoselectpatientsforthrombolytictherapy2)Endovasculartechniquestoachieverecanalization:-MechanicalmethodswithoutthrombolysisforlaterstrokesThijsetal.1loo
3、kedat12patientswithacutestroke<7hoursEachpatientwasnotedtohave>20%PWI/DWImismatchMRIobtainedat4to7daysafterstroketocomparefinalinfarctvolumetoinitialDWIlesion1ThijsVNetal.Neurology2001ExampleofPWI/DWImismatchandfinalinfarctThisstudydemonstratedthatpatientswithanincreasedmeantransittimet
4、heDWIlesionexpandedintowhatwasexpectedonPWIAsecondstudybyTongetal.1showedthattheinitialNIHSSatadmissioncorrelatedmorestronglywithPWIandfinalinfarctvolumeonday7asopposedtoinitialDWIlesion1TongDCetal.Neurology1998CerebralBloodFlowchangesinAcuteIschemicStrokeTissueoutcomefollowingarterialo
5、cclusionisdeterminedbycerebralbloodflowthresholdsbelowwhichneuronalintegrityandfunctionisdifferentiallyaffected11BaronJC,CerebrovascDis2001CBFthresholdsinhumancerebralischemiaISCHEMICPENUMBRATissuethatisfunctionallyimpairedbutstructurallyintactCBFrange12-20mL/100g/minSalvagingthistissue
6、byrestoringitsflowtonon-ischemiclevelsistheaimofreperfusiontherapyPenumbraconvertstoischemiccorewithhyperglycemia,acidosis,reducedlocalperfusionpressure1Baronet.al,CerebrovascDis2001,2Heissetal.2001CerebralBloodFlowchangesinAcuteIschemicStroketissueirreversiblydamagedbeyondacertaintimel
7、imititcorrespondstoCBFvaluesoflessthan12ml/100g/min4,5thrombolytictherapyadministeredtopatientswithlargeamountsofcoreisassociatedwithanincreasedriskofsymptomatichemorrhageandmalignantcerebraledema6,7,8,9,104Baronet.al,CerebrovascDis2001,5Heissetal,Stroke2000,6Goldsteinetal.,Str
