急性缺血性卒中治疗的新曙光──机械取栓治疗.docVIP

急性缺血性卒中治疗的新曙光 ──机械取栓治疗 陈康宁（400038重庆，第三军医大学西南医院神经内科，重庆市缺血性卒中介入诊治研究所） [关键词] 缺血性卒中；血管再通；机械取栓装置；支架 The highlight of therapy in acute ischemic stroke: mechanical thrombectomy therapy Chen kangning (Department of Neurology ,Institute of Interventional Diagnosis and Treatment of Ishemic Stroke of Chongqing,Southwest Hospital,Third Military Medical University,Chongqing,40038,China ) [Abstract] Stroke is the first leading cause of death and the leading cause of disability in China.Early vessel recanalization in acute ischemic stroke has been shown to strongly correlate with improved clinical outcome and reduced mortality. Mechanical Thrombectomy devices were introduced in the late 1990s and the highly effective stent retriever was recently included. Stent retriever have recently been shown to be safe and effective up to 8 h after the onset of stroke symptoms. In addition to expanding the therapeutic time window for stroke treatment and broadening the treatment repertoire, mechanical approaches have been shown to produce higher recanalization rates than intravenous tissue plasminogen activator (tPA) or intra-arterial (IA) thrombolysis alone. The stent retriever seems to be the definitive first choice in the use of mechanical devices for intra-arterial recanalization treatment in acute ischemic stroke. [Key word] ischemic stroke; vessel recanalization ;Mechanical Thrombectomy devices; Stent retriever 卒中已经成为了全世界范围内发病率、复发率、致残率及致死率最高的慢性疾病，尤其是在我国。2008年《中国第三次回顾性死因抽查调查报告》显示，卒中导致的死亡超过了恶性肿瘤、呼吸系统疾病及心血管病，位居死因第1位。而且，在我国，卒中的发病率及复发率还在增加。所以，缺血性卒中的防治成为了各国政府、尤其是我国政府关心的问题。 占卒中绝大部分比例的是缺血性卒中。在过去的十多年的时间，缺血性卒中预防有了很大的进展，而缺血性卒中的治疗始终停留在48h抗血小板治疗、抗凝治疗、溶栓时间窗内的静脉溶栓及入住卒中单元4种方法。无论那种方法，急性缺血卒中的血运重建治疗是治疗的关键！在过去，缺血性卒中急性期r-tPA)的静脉溶栓治疗仍然是血运重建的标准治疗。但是这种标准治疗存在两大致命的：治疗时间窗段及血运重建率低，限制了其对缺血性卒中的疗效及广泛应用。而近年来发展的新型的机械取栓治疗（mechanial thrombectomy therapy）成为了急性缺血性卒中治疗的亮点，有比静脉或动脉溶栓更高的血运重建率。机械取栓装置最经典的是MERCI是一种基于螺旋旋转的取栓装置。MERCI取栓的有效