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Expansion of the dimensions in the current management of acute ischemic stroke.
Journal of Neurology ( IF 6 ) Pub Date : 2020-05-20 , DOI: 10.1007/s00415-020-09873-6
Preeti Malik 1 , Arsalan Anwar 2 , Ruti Patel 3 , Urvish Patel 4
Affiliation  

Stroke is the fifth leading cause of death in the United States with a huge burden on health care. Acute ischemic stroke (AIS) accounts for 87% of all stroke. The use of thrombolytic agents in AIS treatment is well known since 1950 but no FDA approval until 1996, due to lack of strong evidence showing benefits outweigh the risk of intracranial hemorrhage. The NINDS trial led to the approval of intravenous tissue plasminogen activator treatment (IV recombinant tPA) within 3 h of stroke. Due to this limitation of 3-4.5 h. window, evolution began in the development of effective endovascular therapy (EVT). Multiple trials were unsuccessful in establishing the strong evidence for effectiveness of EVT. In 2015, MR CLEAN trial made progress and showed improved outcomes with EVT in AIS patients with large vessel occlusion (LVO), with 6-h window period. In 2018, two major trials-DAWN and DEFUSE 3-along with few other trials had shown improved outcomes with EVT and stretched window period from 6 to 24 h. AHA Stroke Council is constantly working to provide focused guidelines and recommendations in AIS management since 2013. SVIN had started the initiative "Mission Thrombectomy-2020" to increase global EVT utilization rate 202,000 procedures by 2020. Physicians are using safer and easier approach like brachial and radial approach for EVT. TeleNeurology and artificial intelligence also played a significant role in increasing the availability of IV recombinant tPA in AIS treatment in remote hospitals and also in screening, triaging and identifying LVO patients for EVT. In this review article, we aim to describe the history of stroke management along with the new technological advancements in AIS treatment.

中文翻译:

扩大当前急性缺血性卒中管理的维度。

中风是美国第五大死因,对医疗保健造成巨大负担。急性缺血性卒中 (AIS) 占所有卒中的 87%。溶栓剂在 AIS 治疗中的使用自 1950 年以来就广为人知,但直到 1996 年才获得 FDA 的批准,因为缺乏强有力的证据表明其益处大于颅内出血的风险。NINDS 试验导致批准在中风后 3 小时内进行静脉组织纤溶酶原激活剂治疗(IV 重组 tPA)。由于 3-4.5 小时的限制。窗口,进化始于有效血管内治疗 (EVT) 的开发。多项试验未能成功证明 EVT 的有效性。2015 年,MR CLEAN 试验取得进展,并显示 EVT 在大血管闭塞 (LVO) 的 AIS 患者中得到改善,窗口期为 6 小时。2018 年,两项主要试验——DAWN 和 DEFUSE 3——以及少数其他试验表明 EVT 的结果有所改善,窗口期从 6 小时延长到 24 小时。自 2013 年以来,AHA 卒中委员会一直致力于为 AIS 管理提供有针对性的指导方针和建议。 SVIN 发起了“使命血栓切除术 - 2020”计划,以在 2020 年之前提高全球 EVT 使用率 202,000 个程序。医生正在使用更安全、更简单的方法,如肱动脉和EVT 的径向方法。TeleNeurology 和人工智能在提高远程医院 AIS 治疗中 IV 重组 tPA 的可用性以及筛查、分类和识别 LVO 患者的 EVT 方面也发挥了重要作用。在这篇评论文章中,
更新日期:2020-05-20
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