Progress in the Treatment of Acute Ischemic Stroke, Current Challenges and the Establishment of Clinical Decision-Making System

Yi Bao, Xinyu Du, Miao Zhang, Ran An, Jing Xiao, Xiaodong Liu, Guangjian Liu

Abstract


Ischemic stroke often occurs in middle-aged and elderly people, leading to brain tissue ischemia, hypoxia and necrosis. The clinical manifestations are a series of neurological deficits, such as aphasia, hemiplegia and disturbance of consciousness, with high morbidity, mortality, disability rate, recurrence rate and multiple complications. This article aims to review current treatment advances, analyze current challenges and propose coping strategies. The literature on stroke treatment and the latest technological progress were reviewed. Combined with clinical and epidemiological to analyze the current challenges, the coping strategies were proposed before, during and after thrombolysis. Early intravenous thrombolysis and bridging treatment can restore blood perfusion in time and save the ischemic penumbra of brain tissue. However, the current proportion of patients receiving thrombolytic therapy is very low. The main challenges are as follows: easy to miss the time window, door-to-needle time is too long and there is a lack of understanding of the safety and efficacy of thrombolysis, especially the hemorrhagic transformation. A clinical decision-making system is established for stroke rescue by improving the popularization rate of stroke thrombolytic therapy, optimizing the green channel process of stroke and improving the executive ability of clinicians, to shorten the rescue time. Advanced imaging techniques are used to identify potential patients for thrombolysis. Acute intravascular bridge therapy is used to improve the efficacy of thrombolysis. Screening before thrombolysis, timely thrombolytic therapy, re-examination after thrombolysis and active response to hemorrhagic transformation can effectively improve the safety and acceptability of treatment.




J Neurol Res. 2019;9(4-5):51-59
doi: https://doi.org/10.14740/jnr541

Keywords


Acute ischemic stroke; Thrombolysis; Bridge therapy; Hemorrhagic transformation

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