Endovascular thrombectomy for stroke: current best practice and future goals
作者机构：Department of Medicine and NeurologyMelbourne Brain Centre at the Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia Department of RadiologyRoyal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
出 版 物：《Stroke & Vascular Neurology》 (卒中与血管神经病学（英文）)
年 卷 期：2016年第1卷第1期
页 面：16-22页
核心收录：
基 金：Codman Johnson and Johnson Florey Institute of Neuroscience and Mental Health National Stroke Foundation of Australia Royal Melbourne Hospital Foundation Bristol-Myers Squibb, BMS AstraZeneca Medtronic Boehringer Ingelheim Merck Sharp and Dohme, MSD National Health and Medical Research Council, NHMRC, (GNT1035688, GNT1043242) National Heart Foundation of Australia Royal Australasian College of Physicians, RACP Covidien
摘 要：Endovascular thrombectomy for large vessel ischaemic stroke substantially reduces disability,with recent positive randomised trials leading to guideline changes *** review discusses in detail the evidence provided by recent randomised trials and metaanalyses,the remaining areas of uncertainty and the future directions for *** data from existing trials have demonstrated the robust benefit of endovascular thrombectomy for internal carotid and proximal middle cerebral artery *** remains for more distal occlusions where the efficacy of alteplase is greater,less tissue is at risk and the safety of endovascular procedures is less *** artery occlusion was excluded from the trials,but with a dire natural history and proof of principle that rapid reperfusion is effective,it seems reasonable to continue treating these patients pending ongoing trial *** has been no evidence of heterogeneity in treatment effect in clinically defined subgroups by age,indeed,those aged80 years have at least as great an overall reduction in disability and reduced *** there was no heterogeneity across the range of baseline stroke severities included in the *** that routine use of general anaesthesia reduces the benefit of endovascular thrombectomy is increasing and conscious sedation is generally preferred unless severe agitation or airway compromise is *** impact of time delays has become clearer with description of onset to imaging and imaging to reperfusion *** in the onset to imaging reduce the proportion of patients with salvageable brain ***,in the presence of favourable imaging,rapid treatment appears beneficial regardless of the onset to imaging time *** to reperfusion delays lead to decay in the clinical benefit achieved,particularly in those with less robust collateral *** brain imaging options to assess prognosis have various advantages and disadvan
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