Research progress on hyperacute reperfusion therapies for patients with severe ischemic stroke_West China Medical Journal

Authors：

HUANG Linrui ,  WU Simiao

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WU Simiao, Email: simiao.wu@hotmail.com

Keywords：

Severe ischemic stroke; large hemispheric infarction; reperfusion therapy; intravenous thrombolysis; endovascular treatment; blood pressure management

DOI：

10.7507/1002-0179.202303139

Video：

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Severe ischemic stroke is characterized by severe neurological deficits, sometimes accompanied by cardiovascular and respiratory dysfunction, which could lead to severe disability and death. This article reviews the national and international trials of reperfusion treatment for severe ischemic stroke in recent 20 years, and summarizes relevant clinical guidelines and expert consensuses. In general, intravenous thrombolysis is not restricted for patients with severe neurological deficits, but should be cautiously considered for patients with large infarction. Patients with large vessel occlusion could benefit from endovascular treatment, and whilst prevention and treatment for brain edema are important for patients with very large infarction. For patients who have received reperfusion therapies, the target for the management of blood pressure should incorporate the status of recanalization and a stable level of blood pressure should be maintained.

Citation： HUANG Linrui, WU Simiao. Research progress on hyperacute reperfusion therapies for patients with severe ischemic stroke. West China Medical Journal, 2023, 38(5): 734-742. doi: 10.7507/1002-0179.202303139 Copy

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2. 吴思缈, 吴波, 郭富强, 等. 重症脑梗死优化诊治方案及流程建议草案. 华西医学, 2019, 34(10): 1096-1108.
3. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med, 2008, 359(13): 1317-1329.
4. Wu S, Mair G, Cohen G, et al. Hyperdense artery sign, symptomatic infarct swelling and effect of alteplase in acute ischaemic stroke. Stroke Vasc Neurol, 2021, 6(2): 238-243.
5. 中华医学会神经外科学分会, 国家卫健委脑卒中筛查与防治工程委员会, 海峡两岸医药卫生交流协会神经外科分会缺血性脑血管病学组. 大面积脑梗死外科治疗指南. 中华医学杂志, 2021, 101(45): 3700-3711.
6. 吴思缈, 袁若圳, 刘鸣. 应当提倡大面积脑梗死后恶性脑水肿的预防理念及其研究. 中华神经科杂志, 2020, 53(4): 244-249.
7. Wu S, Anderson CS. Precision management of brain oedema after acute ischaemic stroke. Precis Clin Med, 2022, 5(3): pbac019.
8. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
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11. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med, 1995, 333(24): 1581-1587.
12. Saver JL. Hemorrhage after thrombolytic therapy for stroke: the clinically relevant number needed to harm. Stroke, 2007, 38(8): 2279-2283.
13. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA, 1995, 274(13): 1017-1025.
14. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian acute stroke study investigators. Lancet, 1998, 352(9136): 1245-1251.
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