Đối Mặt Với Thời Gian Trong Đột Quỵ Ischemic: Một Giả Thuyết Thay Thế Về Sự Thất Bại Của Mạch Tăng Cường

Springer Science and Business Media LLC - Tập 26 - Trang 141-151 - 2016
M. Pham1, M. Bendszus1
1Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany

Tóm tắt

Nhiều thử nghiệm ngẫu nhiên có đối chứng gần đây đã chứng minh rằng đột quỵ ischemic do tắc nghẽn động mạch não lớn có thể được điều trị hiệu quả bằng phương pháp thông tim nội mạch. Trong số các nghiên cứu này, đặc biệt là dữ liệu từ nghiên cứu ESCAPE đã củng cố mối liên hệ mạnh mẽ giữa dòng máu bổ sung từ mạch máu lớn (trước khi thông tim) và kết quả lâm sàng sau khi thông tim. Bài tổng quan này cung cấp cái nhìn tổng quát về các dữ liệu này và các quan sát lâm sàng chính minh chứng cho mối liên hệ này trong thực tiễn. Bởi vì vùng ischemic penumbra chỉ có thể được duy trì nhờ dòng chảy bổ sung, nên việc suy giảm dòng máu bổ sung hoặc việc làm đầy kém của mạch bổ sung, được quan sát qua DSA hoặc CTA trước khi thông tim, dường như là nguyên nhân chính gây ra tình trạng nhồi máu tiến triển nhanh chóng và việc thông tim không hiệu quả. Tuy nhiên, cần nhấn mạnh rằng mối quan hệ nguyên nhân-kết quả thực sự giữa sự thất bại của mạch bổ sung và tình trạng nhồi máu tiến triển nhanh chóng của penumbra, tức là khả năng cao về kết quả lâm sàng không thuận lợi mặc dù đã thông tim, vẫn chưa rõ ràng. Theo hướng này, một giả thuyết thay thế được đưa ra, xem việc suy giảm dòng chảy bổ sung không phải là nguyên nhân mà có thể là hậu quả thứ cấp không thể tránh khỏi của sự gia tăng kháng lực ngoại vi/mạch vi trong quá trình nhồi máu tiến triển.

Từ khóa

#đột quỵ ischemic #thông tim nội mạch #tắc nghẽn động mạch #dòng chảy bổ sung #nghiên cứu ESCAPE

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