Aortic occlusion for cerebral ischemia: From theory to practice

被引：35

作者：

Liebeskind D.S. ^{[1
]}

机构：

[1] UCLA Stroke Center, Department of Neurology, Los Angeles, CA 90095

来源：

Current Cardiology Reports | 2008年 / 10卷 / 1期

关键词：

Ischemic Stroke; Cerebral Ischemia; Acute Ischemic Stroke; Cerebral Perfusion; Mechanical Thrombectomy;

D O I：

10.1007/s11886-008-0007-3

中图分类号：

学科分类号：

摘要：

Ischemic stroke is a devastating disorder with limited treatment options. Arterial recanalization with thrombolysis or mechanical thrombectomy may be used to restore perfusion in only a subset of cases. Collateral therapeutic strategies such as partial aortic occlusion attempt to reverse ischemia, the principal detrimental element in stroke pathophysiology. This article considers the theoretic basis of aortic occlusion as a therapeutic strategy for cerebral ischemia, procedural details employing the NeuroFlo (CoAxia, Maple Grove, MN) device, ongoing and prior clinical studies, and potential practice implications in the future. The hemodynamic mechanisms associated with flow redistribution due to aortic occlusion and impact on the dynamic role of collateral perfusion in the ischemic brain are considered. Targeting ischemia rather than clot disruption or consideration of venous hemodynamics and flow redistribution may initiate a radical transformation in stroke care. Ultimately, demonstration of a rational mechanism that averts ischemia will be essential. © Current Medicine Group LLC 2008.

引用

页码：31 / 36

页数：5

共 38 条

[1] Liebeskind D.S., Kasner S.E., Neuroprotection for ischaemic stroke: An unattainable goal?, CNS Drugs, 15, pp. 165-174, (2001)
[2] Heiss W.D., Graf R., The ischemic penumbra, Curr Opin Neurol, 7, pp. 11-19, (1994)
[3] Hossmann K.A., Pathophysiology and therapy of experimental stroke, Cell Mol Neurobiol, 26, pp. 1057-1083, (2006)
[4] Liebeskind D.S., Collateral circulation, Stroke, 34, pp. 2279-2284, (2003)
[5] Smith W.S., Sung G., Starkman S., Et al., Safety and efficacy of mechanical embolectomy in acute ischemic stroke: Results of the MERCI trial, Stroke, 36, pp. 1432-1438, (2005)
[6] Tissue plasminogen activator for acute ischemic stroke, N Engl J Med, 333, pp. 1581-1587, (1995)
[7] Alexandrov A.V., Grotta J.C., Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator, Neurology, 59, pp. 862-867, (2002)
[8] Liebeskind D.S., Collaterals in acute stroke: Beyond the clot, Neuroimaging Clin N Am, 15, pp. 553-573, (2005)
[9] Topline Results of Phase III Study in Acute Ischemic Stroke (DIAS-2) Do Not Demonstrate Difference Between Desmoteplase and Placebo, (2007)
[10] Liebeskind D.S., Neuroprotection from the collateral perspective, IDrugs, 8, pp. 222-228, (2005)

← 1 2 3 4 →