Reperfusion therapy for ischemic stroke


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Ischemic stroke (IS) occupies a priority position in the structure of acute cerebrovascular events and is an important social problem due to the high rates of its incidence, mortality and disability. The most successful method of treating ischemic stroke is the method of reperfusion therapy in the first hours of the onset of the disease, which is aimed to restoration of blood flow in the occluded artery. There are 2 main methods of reperfusion in IS - systemic thrombolytic therapy (STLT) with recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy. Systemic TLT with alteplase is the «gold» standard for the treatment of IS patients in the first 4.5 hours from the onset of the disease in the absence of contraindications. The safety and efficacy of alteplase in cerebral stroke have been demonstrated in many randomized clinical trials; blood clots in larger vessels, however, are poorly susceptible to the pharmacological effects of alteplase, which reduces the effectiveness of systemic TLT in cases of occlusion of proximal intracranial arteries. The results of large randomized MRCLEAN, ESCAPE, EXTEND-IA, SWIFTPRIME, and REVASCAT trials were published in 2015, and the class and level of evidence 1A was assigned to the thrombectomy, and in 2018 this treatment was included in the updated American Heart Association/American Stroke Association recommendations for early management of patients with acute IS.

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作者简介

Lyudmila Laypanova

City Clinical Hospital №31 of the Moscow Healthcare Department; Pirogov Russian National Research Medical University

Email: Mizheva54@mail.ru
neurologist, City Clinical Hospital № 31; postgraduate student at the Department of Neurology, Neurosurgery and Medical Genetics, Faculty of Medicine, Pirogov Russian National Research Medical University Moscow, Russia

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