溶栓评估及再通选择PPT.ppt

急性脑梗死诊治热点：溶栓出血预测及血管再通方法选择;血管再通方法Methods in recanalization;Fast recanalization and subsequent reperfusion is the main objective to be achieved in acute ischemic stroke with arterial occlusion  To date, the most effective therapy for treatment of acute ischemic stroke is intravenous rtPA (4.5hours) Other methods of recanalization became hot topics in recent years because of limitations of iv rtPA. ;Limitations of iv. rtPA;Lou M, Safdar A, Mehdiratta M, Kumar S, Schlaug G, Caplan L, Searls D, Selim M. The?HAT?Score: a simple grading scale for predicting?hemorrhage?after ?thrombolysis. Neurology. 2008;71(18):1417-23.;SPAN -100量表 (stroke prognostication using age and NIH Stroke Scale-100);SITS量表 (Safe Implementation of Thrombolysis in Stroke);;THRIVE (Totaled Health Risks in Vascular Events)量表; THRIVE量表 能在亚洲人群（尤其是中国人）预测出血转化风险吗？;本期推荐阅读文章;社论：21世纪预后估计与卒中治疗的艺术;用2分作为分界点评估出血转化的风险 （心源性脑梗死：敏感性:62.5%,特异性:73.5%；非心源性脑梗死：敏感性:71.2%,特异性: 65.6%) ; THRIVE量表预测出血转化的ROC曲线，无论是心源性脑梗死还是非心源性脑梗死其ROC曲线值都大于0.5（心源性脑梗死: ROC=0.602 ；非心源性脑梗死:ROC=0.608 ) ;;动脉溶栓Intra-arteral thrombolysis;What about the Evidence?;PROACT II Trial;What about the Evidence?;Meta-analysis of RCTs;Meta-analysis of RCTs; 桥接 (Bridging) Combined IV and IA thrombolysis;Combined (Bridging) Therapy;Bridging Therapy;Bridging Therapy; The?Interventional?Management?of?Stroke?(IMS-III?trial ) The patients who had received intravenous t-PA within 3 hours after symptom onset were randomly assigned to receive additional endovascular therapy or intravenous t-PA alone, in a 2:1 ratio The primary outcome measure: a modified Rankin scale score of 2 or less at 90 days; ( The?Interventional?Management?of?Stroke?(IMS)-III?trial ) The study was stopped early because of futility after 656 participants had undergone randomization (434 patients to endovascular therapy and 222 to intravenous t-PA alone) The primary outcome measure did not differ significantly according to treatment (40.8% VS 38.7%, endovascular therapy VS intravenous t-P