Mechanical thrombectomy for the treatment of acute ischemic stroke

被引:12
作者
Fields, Jeremy D. [2 ,3 ]
Lindsay, Kurt [4 ]
Liu, Kenneth C. [5 ,6 ]
Nesbit, Gary M. [7 ]
Lutsep, Helmi L. [1 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Neurol, Oregon Stroke Ctr, CR 131,3181 SW Sam Jackson Rd, Portland, OR 97239 USA
[2] Dept Neurol, Neurosci Crit Care, Portland, OR USA
[3] Oregon Hlth & Sci Univ, Dotter Intervent Inst, Intervent Neuroradiol, Portland, OR USA
[4] Oregon Hlth & Sci Univ, Dept Neurol, Oregon Stroke Ctr, Portland, OR USA
[5] Dotter Intervent Inst, Intervent Neuroradiol, Portland, OR USA
[6] Oregon Hlth & Sci Univ, Dept Neurol Surg, Portland, OR USA
[7] Oregon Hlth & Sci Univ, Dept Neurol, Neurosci Crit Care, Portland, OR USA
关键词
acute ischemic stroke; endovascular; IA thrombolysis; interventional; intravenous thrombolysis; mechanical thrombectomy; recanalization;
D O I
10.1586/ERC.10.8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Acute ischemic stroke is the leading cause of severe disability and the third leading cause of death in the USA. Intravenous tissue plasminogen activator (IV tPA) remains the most widely advocated treatment, but this therapy is limited by a narrow time window (< 4.5 h after stroke onset), exclusion of patients with coagulopathy and recanalization rates of less than 50%. As a result, only 5% of acute stroke patients are treated with IV tPA. Endovascular mechanical thrombectomy may be employed, either as a standalone therapy or as an adjunct to IV tPA, and has several potential advantages, including a wider time window (up to 8 h), the capacity for use in coagulopathic patients and higher recanalization rates (up to 82%). Nonetheless, mechanical thrombectomy has engendered controversy because no randomized trials have yet been performed to support its use. In this article, we review the clinical applications of mechanical thrombectomy for the treatment of acute ischemic stroke. Ultimately, the results of ongoing trials are necessary to delineate the patient populations most likely to benefit from this therapy.
引用
收藏
页码:581 / 592
页数:12
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