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Definition,prediction,prevention and management of patients with severe ischemic stroke and large infarction

Chinese Medical Journal 2023年第24期136卷 2912-2922页

作者： Xing Hua Ming Liu Simiao Wu Department of Neurology West China HospitalSichuan UniversityChengduSichuan 610041China Center of Cerebrovascular Diseases West China HospitalSichuan UniversityChengduSichuan 610041China

Severe ischemic stroke carries a high rate of disability and death.The severity of stroke is often assessed by the degree of neurological deficits or the extent of brain infarct,defined as severe stroke and large infarction,respectively.Critically severe stroke is a life-threatening condition that requires neurocritical care or neurosurgical intervention,which includes stroke with malignant brain edema,a leading cause of death during the acute phase,and stroke with severe complications of other vital systems.Early prediction of high-risk patients with critically severe stroke would inform early prevention and treatment to interrupt the malignant course to fatal status.Selected patients with severe stroke could benefit from intravenous thrombolysis and endovascular treatment in improving functional outcome.There is insufficient evidence to inform dual antiplatelet therapy and the timing of anticoagulation initiation after severe stroke.Decompressive hemicraniectomy(DHC)large hemispheric infarction.Studies are ongoing to provide evidence to inform more precise prediction of malignant brain edema,optimal indications for acute reperfusion therapies and neurosurgery,and the individualized management of complications and secondary prevention.We present an evidence-based review for severe ischemic stroke,with the aims of proposing operational definitions,emphasizing the importance of early prediction and prevention of the evolution to critically severe status,summarizing specialized treatment for severe stroke,and proposing directions for future research.

关键词： Severe stroke large infarction Malignant brain edema Critically severe stroke Definition Prediction Prevention Management

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