急性缺血性卒中血管再通治疗后早期神经功能恶化研究进展

doi:10.11958/20220310

天津医药 ›› 2022, Vol. 50 ›› Issue (11): 1227-1232.doi: 10.11958/20220310

• 综述 • 上一篇

急性缺血性卒中血管再通治疗后早期神经功能恶化研究进展

柳洁¹(), 夏盼¹, 潘春华², 李航², 王泽颖³^,^△()

1 潍坊医学院（邮编261042）
2 山东中医药大学
3 潍坊市中医院

收稿日期:2022-03-02 修回日期:2022-06-14 出版日期:2022-11-15 发布日期:2022-11-11
通讯作者: 王泽颖 E-mail:lj15610189128@163.com;wshan63@163.com
作者简介:柳洁（1994），女，硕士在读，主要从事中西医结合临床脑病方面研究。E-mail：lj15610189128@163.com
基金资助:
山东省名老中医药专家传承工作室建设项目(鲁卫函[2019]92号);齐鲁医派中医学术流派传承项目(鲁卫函[2020]132号);潍坊市2020年科技发展计划项目(2020YX019)

Research progress on early neurological deterioration after vascular recanalization in acute ischemic stroke

LIU Jie¹(), XIA Pan¹, PAN Chunhua², LI Hang², WANG Zeying³^,^△()

1 Weifang Medical College, Weifang 261042, China
2 Shandong University of Traditional Chinese Medicine
3 Weifang Hospital of Traditional Chinese Medicine

Received:2022-03-02 Revised:2022-06-14 Published:2022-11-15 Online:2022-11-11
Contact: WANG Zeying E-mail:lj15610189128@163.com;wshan63@163.com

柳洁, 夏盼, 潘春华, 李航, 王泽颖. 急性缺血性卒中血管再通治疗后早期神经功能恶化研究进展[J]. 天津医药, 2022, 50(11): 1227-1232.

LIU Jie, XIA Pan, PAN Chunhua, LI Hang, WANG Zeying. Research progress on early neurological deterioration after vascular recanalization in acute ischemic stroke[J]. Tianjin Medical Journal, 2022, 50(11): 1227-1232.

摘要/Abstract

摘要：

血管再通治疗已成为急性缺血性卒中（AIS）的有效治疗方法，但由于出血转化、不良再灌注、血管再闭塞等各种因素的影响，有部分AIS患者在接受血管再通治疗后会出现早期神经功能恶化（END），主要表现为病情进展、神经功能损伤加重，严重影响患者预后。目前END尚无统一的名称及诊断标准，有关再通治疗后END的研究结果亦不尽相同。就再通治疗后END发病机制、危险因素以及预测因子等相关内容进行综述。

关键词: 卒中, 急性缺血性卒中, 血管内治疗, 静脉溶栓, 早期神经功能恶化, 综述

Abstract:

Recanalization therapy has become an effective treatment for acute ischemic stroke (AIS), but due to the influence of various factors such as bleeding transformation, poor reperfusion and vascular reocclusion, some AIS patients will experience early neurological deterioration (END) after recanalization therapy, which is mainly manifested as disease progression and aggravated neurological impairment, seriously affecting the prognosis of patients. At present, there is no uniform name and diagnostic criteria for END, and results of studies on END after recanalization therapy are also different. This article reviews the pathogenesis, risk factors and predictors of END after recanalization therapy.

Key words: stroke, acute ischemic stroke, endovascular treatment, intravenous thrombolysis, early neurologic deterioration, review

中图分类号:

R743.3

参考文献 47

[1]	WANG W, JIANG B, SUN H, et al. Prevalence,incidence,and mortality of stroke in china:Results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017, 135(8):759-771. doi:10.1161/CIRCULATIONAHA.116.025250.
[2]	PRZYKAZA L. Understanding the connection between common stroke comorbidities,their associated inflammation,and the course of the cerebral ischemia/reperfusion cascade[J]. Front Immunol, 2021, 12:782569. doi:10.3389/fimmu.2021.782569.
[3]	POWERS W J, RABINSTEIN A A, 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[J]. Stroke, 2019, 50(12):e344-e418. doi:10.1161/STR.0000000000000211.
[4]	LEE V H, THAKUR G, NIMJEE S M, et al. Early neurologic decline in acute ischemic stroke patients receiving thrombolysis with large vessel occlusion and mild deficits[J]. J Neurointerv Surg, 2020, 12(11):1085-1087. doi:10.1136/neurintsurg-2020-015871.
[5]	HSU C Y, CHENG C Y, TSAI Y H, et al. Perfusion-diffusion mismatch predicts early neurological deterioration in anterior circulation infarction without thrombolysis[J]. Curr Neurovasc Res, 2015, 12(3):277-282. doi:10.2174/1567202612666150605122536.
[6]	VAN KRANENDONK K R, TREURNIET K M, BOERS A M M, et al. Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion[J]. J Neurointerv Surg, 2019, 11(5):464-468. doi:10.1136/neurintsurg-2018-014141.
[7]	HAO Y, LIU W, WANG H, et al. Prognosis of asymptomatic intracranial hemorrhage after endovascular treatment[J]. J Neurointerv Surg, 2019, 11(2):123-126. doi:10.1136/neurintsurg-2018-013848.
[8]	KIM J S, KIM Y J, LEE K B, et al. Low- versus standard-dose intravenous alteplase in the context of bridging therapy for acute ischemic stroke:a Korean ENCHANTED study[J]. J Stroke, 2018, 20(1):131-139. doi:10.5853/jos.2017.01578.
[9]	ARBA F, PICCARDI B, PALUMBO V, et al. Blood-brain barrier leakage and hemorrhagic transformation:the reperfusion injury in ischemic stroke (RISK) study[J]. Eur J Neurol, 2021, 28(9):3147-3154. doi:10.1111/ene.14985.
[10]	LIU X, DAI Q, YE R, et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST):an open-label,randomised controlled trial[J]. Lancet Neurol, 2020, 19(2):115-122. doi:10.1016/s1474-4422(19)30395-3.
[11]	GIROT J B, RICHARD S, GARIEL F, et al. Predictors of unexplained early neurological deterioration after endovascular treatment for acute ischemic stroke[J]. Stroke, 2020, 51(10):2943-2950. doi:10.1161/STROKEAHA.120.02949.
[12]	FABRITIUS M P, WOLFER T A, HERZBERG M, et al. Course of early neurologic symptom severity after endovascular treatment of anterior circulation large vessel occlusion stroke:association with baseline multiparametric CT imaging and clinical parameters[J]. Diagnostics(Basel), 2021, 11(7):1272. doi:10.3390/diagnostics11071272.
[13]	WONG G J, YOO B, LIEBESKIND D, et al. Frequency,determinants,and outcomes of emboli to distal and new territories related to mechanical thrombectomy for acute ischemic stroke[J]. Stroke, 2021, 52(7):2241-2249. doi:10.1161/STROKEAHA.120.033377.
[14]	WELCH J C, ERKMEN K, GENTILE N. Changes in procoagulant blood biomarkers after mechanical thrombectomy[J]. J Stroke Cerebrovasc Dis, 2021, 30(6):105772. doi:10.1016/j.jstrokecerebrovasdis.2021.105772.
[15]	MARTO J P, STRAMBO D, HAJDU S D, et al. Twenty-four-hour reocclusion after successful mechanical thrombectomy:associated factors and long-term prognosis[J]. Stroke, 2019, 50(10):2960-2963. doi:10.1161/STROKEAHA.119.026228.
[16]	BRONDANI R, DE ALMEIDA A G, CHERUBINI P A, et al. Risk factors for epilepsy after thrombolysis for ischemic stroke:a cohort study[J]. Front Neurol, 2019, 10:1256. doi:10.3389/fneur.2019.01256.
[17]	BRIGO F, SCHNEIDER M, WAGENPFEIL G, et al. Intravenous thrombolysis with tPA and cortical involvement increase the risk of early poststroke seizures:results of a case-control study[J]. Epilepsy Behav, 2020, 104(Pt B):106312. doi:10.1016/j.yebeh.2019.04.056.
[18]	MOHAMMADEN M H, STAPLETON C J, BRUNOZZI D, et al. Risk factors for distal clot migration during mechanical thrombectomy of anterior circulation large vessel occlusion[J]. Cerebrovasc Dis, 2020, 49(2):185-191. doi:10.1159/000507341.
[19]	AWADH M, MACDOUGALL N, SANTOSH C, et al. Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke:incidence and association with atrial fibrillation[J]. Stroke, 2010, 41(9):1990-1995. doi:10.1161/STROKEAHA.109.569459.
[20]	STEFFEL J, VERHAMME P, POTPARA T S, et al. The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J]. Eur Heart J, 2018, 39(16):1330-1393. doi:10.1093/eurheartj/ehy136.
[21]	WU H M, LEE I H, LUO C B, et al. Clinical-CT mismatch defined NIHSS ≥8 and CT-ASPECTS ≥9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke[J]. PLoS One, 2021, 16(4):e0251077. doi:10.1371/journal.pone.0251077.
[22]	PISTOCCHI S, STRAMBO D, BARTOLINI B, et al. MRI software for diffusion-perfusion mismatch analysis may impact on patients' selection and clinical outcome[J]. Eur Radiol, 2022, 32(2):1144-1153. doi:10.1007/s00330-021-08211-2.
[23]	GAWLITZA M, GRAGERT J, QUÄSCHLING U, et al. FLAIR-hyperintense vessel sign,diffusion-perfusion mismatch and infarct growth in acute ischemic stroke without vascular recanalisation therapy[J]. J Neuroradiol, 2014, 41(4):227-233. doi:10.1016/j.neurad.2013.10.004.
[24]	DENG P P, WU N, CHEN X J, et al. NIHSS-the Alberta Stroke Program Early CT Score mismatch in guiding thrombolysis in patients with acute ischemic stroke[J]. J Neurol, 2022, 269(3):1515-1521. doi:10.1007/s00415-021-10704-5.
[25]	KIM B J, LEE Y, KWON B, et al. Clinical-diffusion mismatch is associated with early neurological improvement after late-window endovascular treatment[J]. Cerebrovasc Dis, 2022, 51(3):331-337. doi:10.1159/000519310.
[26]	ALAWNEH J A, JONES P S, MIKKELSEN I K, et al. Infarction of 'non-core-non-penumbral' tissue after stroke:multivariate modelling of clinical impact[J]. Brain, 2011, 134(Pt 6):1765-1776. doi:10.1093/brain/awr100.
[27]	SUN H, LIU Y, GONG P, et al. Intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign:a Meta-analysis[J]. Acta Neurol Scand, 2020, 141(3):193-201. doi:10.1111/ane.13177.
[28]	DARCOURT J, GARCIA C, PHUONG D M, et al. Absence of susceptibility vessel sign is associated with aspiration-resistant fibrin/platelet-rich thrombi[J]. Int J Stroke, 2021, 16(8):972-980. doi:10.1177/1747493020986626.
[29]	KONERU S, NOGUEIRA R G, OSEHOBO E, et al. Clot composition in retrieved thrombi after mechanical thrombectomy in strokes due to carotid web[J]. J Neurointerv Surg, 2021, 13(6):530-533. doi:10.1136/neurintsurg-2020-017112.
[30]	BELACHEW N F, DOBROCKY T, ALEMAN E B, et al. SWI susceptibility vessel sign in patients undergoing mechanical thrombectomy for acute ischemic stroke[J]. AJNR Am J Neuroradiol, 2021, 42(11):1949-1955. doi:10.3174/ajnr.A7281.
[31]	MEREUTA O M, FITZGERALD S, CHRISTENSEN T A, et al. High-resolution scanning electron microscopy for the analysis of three-dimensional ultrastructure of clots in acute ischemic stroke[J]. J Neurointerv Surg, 2021, 13(10):906-911. doi:10.1136/neurintsurg-2020-016709.
[32]	BRINJIKJI W, MADALINA MEREUTA O, DAI D, et al. Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke:lessons from retrieved stroke emboli[J]. Stroke Vasc Neurol, 2021, 6(4):658-667. doi:10.1136/svn-2021-001032.
[33]	ABBASI M, KVAMME P, LAYTON K F, et al. Per pass analysis of thrombus composition retrieved by mechanical thrombectomy[J]. Interv Neuroradiol, 2021, 27(6):815-820. doi:10.1177/15910199211009119.
[34]	OIS A, MARTINEZ-RODRIGUEZ J E, MUNTEIS E, et al. Steno-occlusive arterial disease and early neurological deterioration in acute ischemic stroke[J]. Cerebrovasc Dis, 2008, 25(1/2):151-156. doi:10.1159/000113732.
[35]	CHANG J Y, KIM W J, KWON J H, et al. Prestroke glucose control and functional outcome in patients with acute large vessel occlusive stroke and diabetes after thrombectomy[J]. Diabetes Care, 2021, 44(9):2140-2148. doi:10.2337/dc21-0271.
[36]	MAZIGHI M, RICHARD S, LAPERGUE B, et al. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET):a multicentre,open-label,randomised controlled trial[J]. Lancet Neurol, 2021, 20(4):265-274. doi:10.1016/S1474-4422(20)30483-X.
[37]	FAN K, ZHAO J, CHANG H, et al. Predicting prognosis in patients with stroke treated with intravenous alteplase through the 24-h trajectory of blood pressure changes[J]. J Clin Hypertens (Greenwich), 2021, 23(9):1718-1730. doi:10.1111/jch.14331.
[38]	ANADANI M, ARTHUR A S, ALAWIEH A, et al. Blood pressure reduction and outcome after endovascular therapy with successful reperfusion:a multicenter study[J]. J Neurointerv Surg, 2020, 12(10):932-936. doi:10.1136/neurintsurg-2019-015561.
[39]	ANADANI M, ARTHUR A S, TSIVGOULIS G, et al. Blood pressure goals and clinical outcomes after successful endovascular therapy:a multicenter study[J]. Ann Neurol, 2020, 87(6):830-839. doi:10.1002/ana.25716.
[40]	SUN D, TONG X, HUO X, et al. Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion:incidence,predictors,and clinical impact:data from ANGEL-ACT registry[J]. J Neurointerv Surg, 2022, 14(9):875-880. doi:10.1136/neurintsurg-2021-017956.
[41]	CHOI D W. Excitotoxicity:still hammering the ischemic brain in 2020[J]. Front Neurosci, 2020, 14:579953. doi:10.3389/fnins.2020.579953.
[42]	MARTIN A J, PRICE C I. A systematic review and meta-analysis of molecular biomarkers associated with early neurological deterioration following acute stroke[J]. Cerebrovasc Dis, 2018, 46(5/6):230-241. doi:10.1159/000495572.
[43]	HUO L, CHEN P, WANG Z, et al. Impact of leukoaraiosis severity on the association of outcomes of mechanical thrombectomy for acute ischemic stroke:a systematic review and a meta-analysis[J]. J Neurol, 2021, 268(11):4108-4116. doi:10.1007/s00415-020-10167-0.
[44]	BROOCKS G, KNIEP H, KEMMLING A, et al. Effect of intravenous alteplase on ischaemic lesion water homeostasis[J]. Eur J Neurol, 2020, 27(2):376-383. doi:10.1111/ene.14088.
[45]	CHOI K H, KIM J M, KIM J H, et al. Optimal blood pressure after reperfusion therapy in patients with acute ischemic stroke[J]. Sci Rep, 2019, 9(1):5681. doi:10.1038/s41598-019-42240-8.
[46]	JANG S H, SOHN S I, PARK H, et al. The safety of intra-arterial tirofiban during endovascular therapy after intravenous thrombolysis[J]. AJNR Am J Neuroradiol, 2021, 42(9):1633-1637. doi:10.3174/ajnr.A7203.
[47]	WANG Y, WU X, ZHU C, et al. Bridging thrombolysis achieved better outcomes than direct thrombectomy after large vessel occlusion:an updated meta-analysis[J]. Stroke, 2021, 52(1):356-365. doi:10.1161/STROKEAHA.120.031477.

急性缺血性卒中血管再通治疗后早期神经功能恶化研究进展

Research progress on early neurological deterioration after vascular recanalization in acute ischemic stroke

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

参考文献 47

相关文章 15

编辑推荐

Metrics

本文评价

[1]	郑继青, 龙耀斌, 徐金. 辣椒素联合重复经颅磁刺激用于脑卒中后吞咽障碍患者的疗效观察[J]. 天津医药, 2024, 52(9): 950-953.
[2]	焦爱菊, 任宝龙, 张春花, 李文瑞, 赵玮婧. NIHSS评分联合血清BDNF、IL-6对脑卒中后抑郁的预测价值[J]. 天津医药, 2024, 52(9): 963-966.
[3]	刘智超, 李霄鹤, 周红刚, 张娜. 特发性炎性肌病相关间质性肺疾病动物模型概述[J]. 天津医药, 2024, 52(7): 709-713.
[4]	薛晶, 元小冬, 邢爱君, 王连辉, 马倩, 符永山, 张萍淑. 急性缺血性脑卒中患者睡眠-觉醒生物节律变化与预后的关系研究[J]. 天津医药, 2024, 52(6): 614-619.
[5]	钱洪春, 张萍淑, 元小冬, 袁建新, 曹凌云, 段丽琴. 卒中伴阻塞性睡眠呼吸暂停患者认知功能损害与睡眠参数的关系[J]. 天津医药, 2024, 52(6): 619-624.
[6]	韩琴, 韩秀丽, 陈伟然. 老年脑卒中患者康复治疗后抑郁障碍的影响因素分析[J]. 天津医药, 2024, 52(6): 639-642.
[7]	张丽红, 李瑞青, 王艺莹, 梅紧紧, 苏凯奇, 顾昌宇, 黄梦玲. 督脉电针调控胱氨酸/谷氨酸反向转运体改善脑卒中后肢体痉挛的作用机制[J]. 天津医药, 2024, 52(5): 463-468.
[8]	王月, 权兴苗, 王玉, 宋春侠, 邵月, 徐立伟. 益气升清方调节HIF-1α/NLRP3信号通路对缺血性脑卒中大鼠神经元焦亡的影响[J]. 天津医药, 2024, 52(4): 350-355.
[9]	肖雨倩, 孙可心, 万俊, 陈淑颖, 陈丽敏, 王岩, 白艳杰. RNA m6A甲基化在卒中后认知障碍中的研究进展[J]. 天津医药, 2024, 52(3): 331-336.
[10]	丁波, 龚洁芹, 沈李奎. 急性缺血性脑卒中患者血清指标与病情和预后的关系[J]. 天津医药, 2024, 52(2): 172-176.
[11]	周秀芬, 刘晖, 陈虹, 赵宗波. SAP患者GLI与外周血各指标变化的临床意义[J]. 天津医药, 2024, 52(12): 1286-1291.
[12]	张晶晶, 赵文栋, 赵远, 张清峡, 杜佳, 刘艳霞. CALLY指数对缺血性脑卒中后抑郁的预测价值[J]. 天津医药, 2024, 52(12): 1300-1304.
[13]	孙可心, 肖雨倩, 万俊, 陈淑颖, 陈丽敏, 王岩, 白艳杰. 脑类器官技术及在脑卒中治疗中的应用进展[J]. 天津医药, 2024, 52(1): 38-43.
[14]	王文熠, 陈光. 脑卒中后昼间嗜睡与患者睡眠呼吸障碍的相关性研究[J]. 天津医药, 2023, 51(12): 1369-1373.
[15]	谢云帆, 刘咪, 田毅. 七氟烷对海马神经元凋亡相关信号通路影响的研究进展[J]. 天津医药, 2022, 50(8): 892-896.