Reperfusion therapy for acute ischemic stroke

China has the highest lifetime risk of stroke, with global burden of disease studies showing a lifetime risk of stroke in China at 39.

Patients within 4.

There have been multiple clinical trials evaluating the efficacy and safety of rt-PA venous thrombolysis in acute cerebral infarction, and the treatment time window of the study includes 3h, 3-4.

Indications and contraindications for intravenous thrombolysis of rt-PA within 3 h

Indications:

Contraindication:

Relative contraindications

The following scenarios require careful consideration and weighing of the risks and benefits of thrombolysis

Indications and contraindications for intravenous thrombolysis of rt-PA within 3 to 4.

Indications:

Contraindication:

Relative contraindications:

The following scenarios require careful consideration and weighing of the risks and benefits of thrombolysis

Blood pressure control

A number of clinical randomized trials have shown that the blood pressure of patients with acute stroke should be controlled at 180mmHg of systolic blood pressure <180mmHg and diastolic blood pressure of 100mmHg before receiving alteplase intravenous thrombolytic therapy, and the blood pressure <of patients should be < 180/100mmHg
within 24h after thrombolytic therapy.

Blood sugar control

About 40% of patients have post-stroke hyperglycemia, which is not conducive to prognosis, and the blood glucose value should be controlled at 7.

Other thrombolytic drugs

In addition to rt-PA, different studies have evaluated the efficacy and safety
of urokinase, deamipsin, tenectase intravenous thrombolysis, and ultrasound-assisted venous thrombolysis, respectively.

Patients within 6 hours of onset - bridging/intravascular treatment

Currently, intravenous thrombolytic therapy is the preferred treatment option
for patients with intravenous thrombolysis time window.

Bridging therapy refers to intravascular interventional reperfusion therapy on the basis of intravenous thrombolysis, which is divided into direct bridging therapy and salvage bridging therapy
.

Patients within 6 to 24 hours of onset - intravascular therapy

The publication of the Clinical-Image Mismatch Study of Clinical-Image Mismatch in Patients with Awake Stroke Following the Trevo Interventional Treatment (DAWN) Study and the Imaging Evaluation of Ischemic Stroke Patients with Intravascular Therapy 3 (DEFUSE3) expanded the time window for mechanical thrombosis from the original 6 h to 24 h
.

DAWN study selection criteria

DEFUSE3 Research Inclusion Criteria

Intravascular treatment and treatment procedures for patients with acute ischemic stroke: