急性缺血性卒中再灌注治疗后血管再闭塞
Reocclusion after Reperfusion Therapy in Patients with Acute Ischemic Stroke
DOI: 10.12677/ACM.2019.91010, PDF,   
作者: 季晓康, 谈 跃：昆明医科大学第二附属医院脑血管病科，云南 昆明
关键词: 急性缺血性卒中；溶栓；抗血小板治疗；Acute Ischemic Stroke； Thrombolysis； Antiplatelet Therapy
摘要: 急性缺血性卒中目前最理想的治疗方法仍然是尽快开通闭塞的血管，恢复血流灌注，拯救更多的缺血半暗带组织。静脉溶栓、桥接取栓及机械取栓是目前较为公认的开通血流再灌注的有效治疗方案。但部分患者再灌注后疗效仍不佳，是由于溶栓后的并发症导致神经功能恶化。其中再灌注治疗后出现血管再闭塞，是严重影响溶栓患者预后的原因之一。本文对再灌注治疗急性脑梗死后血管再闭塞可能发生机制、影响因素和可能防治措施进行综述。
Abstract: The most ideal treatment for acute ischemic stroke is still to open the occluded blood vessels as soon as possible and to recover the blood perfusion, so as to save more ischemic penumbra tissue. Intravenous thrombolysis, bridging thrombectomy and mechanical thrombectomy are currently recognized as effective treatment options for reopening blood flow. However, some patients still have poor efficacy after reperfusion, which is due to complications of thrombolysis leading to neurological deterioration. Reocclusion after reperfusion therapy is one of the reasons that seri-ously affect the prognosis of patients with thrombolysis. This article reviews the possible mecha-nism, influencing factors and possible measures of prevention and treatment after reocclusion.
文章引用：季晓康, 谈跃. 急性缺血性卒中再灌注治疗后血管再闭塞[J]. 临床医学进展, 2019, 9(1): 51-56. https://doi.org/10.12677/ACM.2019.91010

参考文献

[1] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组。 中国急性缺血性脑卒中诊治指南2014 [J]. 中华神经科杂志, 2015, 48(4): 246-257.
[2] 中华医学会神经病学分会, 中华医学会神经病学分会神经血管介入协作组, 急性缺血性脑卒中介入诊疗指南撰写组. 中国急性缺血性脑卒中早期血管内介入诊疗指南[J]. 中华神经科杂志, 2015, 48(5): 356-360.
[3] The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue Plasminogen Activator for Acute Ischemic Stroke. New England Journal of Medicine, 333, 1581-1587.
[4] Demchuk, A.M., Burgin, W.S., Christou, I., et al. (2001) Thrombolysis in Brain Ischemia (TIBI) Transcranial Droppler Flow Grades Predict Clinical Severity, Early Recovery, and Morality in Patients Treated with Intravenous Tissue Plaminogin Activator. Stroke, 32, 89-93. [Google Scholar] [CrossRef] 
[5] Rubiera, M., Alvarez-Sabn, J., Ribo, M., et al. (2005) Preditors of Early Arterial Reocculusion after Tissue Plasminogen Acti-vator-Induced Recanalization in Acute Ischemic Stroke. Stroke, 36, 1452-1456. [Google Scholar] [CrossRef] 
[6] Alexandrov, A.V. and Grotta, J.C. (2002) Arterial Reocclusion in Stroke Patients Treated with Intravenous Tissue Plasminogen Activator. Neurology, 59, 862-867. [Google Scholar] [CrossRef] 
[7] Grotta, J.C., Welch, K.M., Fagan, S.C., et al. (2001) Clinical Deteri-oration Following Improvement in the NINDS rt-PA Stroke Trial. Stroke, 32, 661-668. [Google Scholar] [CrossRef] 
[8] Qureshi, A.I., Siddiqui, A.M., Kim S.H., et al. (2004) Reocclusion of Recanalized Ateries during Intra Arterial Thrombolysis for Acute Ischemic Stroke. American Journal of Neuroradi-ology, 25, 322-328.
[9] Janjua, N., Alkawi, A., Suri, M.F.K., et al. (2008) Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic Stroke. American Journal of Neuroradiology, 29, 253-258. [Google Scholar] [CrossRef] 
[10] Baik, S.K., Oh, S.J., Park, K.-P., et al. (2011) Intra-Arterial Tifofiban Infusion for Partial Recanalization with Stagnant Flow in Hyperacute Cerebral Ischemic Stroke. Interventional Neuro-radiology, 17, 442-451. [Google Scholar] [CrossRef] [PubMed]
[11] 孙建, 付慧霄, 孙艳军. 应用RT-PA溶栓治疗脑梗死病人溶栓后血管再闭塞的临床特点[J]. 中国老年学杂志, 2016, 4(36): 1868-1869.
[12] Heo, J.H., Lee, K.Y., Kim, S.H., et al. (2003) Immediate Reocclusion Following a Successful Thrombolysis in Acute Stroke: A Pilot Study. Neurology, 60, 1684-1687. [Google Scholar] [CrossRef] 
[13] del Rio-Espinola, A., Fernan-dez-Cadenas, I., Rubiera, M., et al. (2010) CD40-1C>T Poly Morphism (rs1883832) Is Associated with Brain Vessel Reocclusion after Fibrinolysis in Aschenemic Stroke Patient. Pharmacogenomics, 11, 763-772. [Google Scholar] [CrossRef] [PubMed]
[14] Fernandez-Cadenas, I., Alvarez-Sabin, J., Ribo, M., et al. (2007) Influnce of Tnrombin-Activatable Fibrinolysis Inhibitor and Plasminogin Activator Inhibitor-1 Gene Polymorphisms on Tissue-Type Plasminogen Activator-Induced Recanalization in Ischemic Stroke Patients. Journal of Thrombosis and Haemostasis, 5, 1862-1868. [Google Scholar] [CrossRef] [PubMed]
[15] Fernandez-Cadenas, I., Rubiera, M., et al. (2010) Poly-morphism Is Associated with Brain Vessel Reocclusion after Successful Fibrinolytic Therapy in Ischemic Stroke Patients. International Journal of Neuroscience, 120, 245-251. [Google Scholar] [CrossRef] [PubMed]
[16] 李登星. 尿激酶静脉溶栓后早期血管再闭塞与血液凝血、纤溶活性的临床观察[J]. 中国实用神经疾病杂志, 2010, 13(21): 51-53.
[17] 付睿, 赵星辉, 黄栋, 等. 急性缺血性脑卒中动脉溶栓中血管再闭塞的临床分析[J]. 实用医学杂志, 2011, 27(20): 3737-3739.
[18] Bhatia, R., Hill, M.D., Shobha, N., et al. (2010) Low Rates of Acute Recanalization with Intravenous Recombinant Tissue Plasminogen Acti-vator Inischemic Stroke: Real-World Experience and a Call Foraction. Stroke, 41, 2254-2258. [Google Scholar] [CrossRef] 
[19] Goyal, M., Menon, B.K., Van Zwam, W.H., et al. (2016) Endovascular Thrombectomy after Large-Vessel Ischaemic Stroke: A Meta-Analysis of Individual Patient Data from Five Randomised Trials. The Lancet, 387, 1723-1731. [Google Scholar] [CrossRef] 
[20] 戴征, 李敏, 王怀明, 代齐良, 许剑, 刘新峰. 替罗非班在机械取栓中原位血栓形成导致再闭塞中的应用[J]. 中华神经科杂志, 2017, 50(6): 440-444.
[21] 周志国, 陈静, 朱青峰. Solitaire支架机械取栓术后血管再闭塞病因分析及防治策略[J]. 中国医学创新, 2018, 15(16): 5-9.
[22] 陈振光, 张发惠, 谢昀, 等. 同种异体骨与血管组织深低温冷藏的时限研究[J]. 中华创伤骨科杂志, 2004, 9(6): 1027-1029.
[23] Qureshi, A.I., Siddiqui, A.M., Kim, S.H., et al. (2004) Reocclusion of Recanalized Arteries during Intraarterial Thromholysis for Acute Ischemic Stroke. American Journal of Neuroradiology, 25, 322-328.
[24] Sandercock, P.A., Counsell, C. and Kana, E.J. (2015) Anticoagn Lants for Acute Ischemic Stroke. Cochrane Database of Systematic Reviews, 12, CD000024.
[25] Zinkstok, S.M., Roos, Y.B. and ARTIS Investigators (2012) Early Administration of Aspirin in Patients Treated with Alteplase for Acute Ischaemic Stroke: A Randomized Controlled Trial. The Lancet, 380, 731-737. [Google Scholar] [CrossRef] 
[26] 朱立勋, 耿瑞慧, 陆学胜, 李克良, 丁素菊. 急性脑梗死阿替普酶静脉溶栓后血管再闭塞应用低分子肝素钙的价值[J]. 武警医学, 2015, 26(6): 555-557, 562.
[27] Siebler, M., Hennerici, M.G., Schneider, D., von Reutern, G.M., Seitz, R.J., Rother, J., et al. (2011) Safety of Tirofiban in Acute Ischemic Stroke: The SaTIS Trial. Stroke, 42, 2388-2392. [Google Scholar] [CrossRef] 
[28] Zhao, W., Che, R. and Shang, S. (2017) Low-Dose Tiro-fiban Improves Functional Outcome in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy. Stroke, 48, 3289-3294. [Google Scholar] [CrossRef] 
[29] Zhao, H., Zhang, J., Gu, D., et al. (2017) Tirofiban Fa-cilitates the Reperfusion Process during Endovascular Thrombectomy in ICAS. Experimental and Therapeutic Medicine, 14, 3314-3318. [Google Scholar] [CrossRef] [PubMed]
[30] Lee, K.Y., Heo, J.H., Lee, S.I., et al. (2001) Rescue Treatment with Abciximab in Acute Ischemic Stroke. Neurology, 56, 1585-1587. [Google Scholar] [CrossRef] 

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