РЕНТГЕНОХИРУРГИЯ В ЛЕЧЕНИИ ОСТРЫХ ИНФАРКТОВ И ИНСУЛЬТОВ. СОВРЕМЕННОЕ СОСТОЯНИЕ ВОПРОСА. ЧАСТЬ 2
Обзорная статья
Дата публикации: сентября 16, 2019
Ключевые слова
инфаркт миокарда
инсульт
инсульт
Как цитировать
Реймерс Б. РЕНТГЕНОХИРУРГИЯ В ЛЕЧЕНИИ ОСТРЫХ ИНФАРКТОВ И ИНСУЛЬТОВ. СОВРЕМЕННОЕ СОСТОЯНИЕ ВОПРОСА. ЧАСТЬ 2 // Кремлевская медицина. Клинический вестник. 2019. Т. № 3. С. 82-97.
Аннотация
После того, как Херрик описал клиническую картину острого инфаркта миокарда более 100 лет назад (1912 г.), лечения ОИМ прошло три фазы развития: фаза 1 (1912–1961 гг., постельный режим и «выжидательное» лечение); фаза 2 (1961–1974, создание и развитие отделений и блоков интенсивной кардиологической терапии); и фаза 3 (с 1975 года по настоящее время, реперфузионная тактика лечения ишемии миокарда). Сейчас мы находимся на пороге фазы 4, которая включает в себя усилия по сокращению перфузионного повреждения миокарда, а также регенеративную медицину. Лечение острого ишемического инсульта претерпело кардинальные изменения в последнее время после продемонстрированной эффективности внутриартериальной тромболитической терапии (IA) на основе данных многочисленных исследований. Отбор пациентов для внутривенной и IA-терапии основан на своевременной визуализации с помощью компьютерной томографии или магнитно-резонансной томографии, с последующей прямой ангиографией для документирования окклюзии крупного сосуда, поддающейся вмешательству. Современные методы визуализации являются основой для выявления ишемического ядра и зоны состоявшегося некроза, и эта информация вносить все больший вклад в принятие решений о тактики лечения по мере увеличения терапевтического временного окна. Внутривенный тромболизис с использованием активатора плазминогена тканевого типа остается основой терапии острого инсульта в течение первых 4.5 часов после начала инсульта. У пациентов с проксимальными окклюзиями крупных сосудов лечение следует начинать на основе IA в течение 6 часов после начала инсульта. Организация и внедрение региональных систем лечения инсульта необходимы для лечения как можно большего числа подходящих пациентов. Новые парадигмы лечения, сочетающие нейропротекцию, высокотехнологические методики и терапию, потенциально увеличивает число пациентов, которых можно лечить, несмотря на длительное время транспортировки, и смягчить последствия реперфузионного повреждения. Лечение острого инсульта вступило в золотой век, и можно ожидать многих дополнительных достижений.Литература
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16. Thomalla G, Gerloff C. Treatment concepts for wake-up stroke and stroke with unknown time of symptom onset. Stroke. 2015; 46: 2707–2713. doi: 10.1161/STROKEAHA.115.009701.
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21. Southerland AM, Johnston KC, Molina CA, Selim MH, Kamal N, Goyal M. Suspected large vessel occlusion: should Emergency Medical Services transport to the nearest Primary Stroke Center or bypass to a Comprehensive Stroke Center with endovascular capabilities? Stroke. 2016; 47: 1965–1967. doi: 10.1161/STROKEAHA.115.011149.
22. Purrucker JC, Hametner C, Engelbrecht A, Bruckner T, Popp E, Poli S. Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort. J Neurol Neurosurg Psychiatry. 2015; 86: 1021–1028. doi: 10.1136/jnnp-2014-309260.
23. Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH. The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke. 2012; 43: 2078–2085. doi: 10.1161/ STROKEAHA.111.645861.
24. Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L et al. Benefits of stroke treatment using a mobile stroke unit compared with standard management: The BEST- MSU Study Run-In Phase. Stroke. 2015; 46: 3370–3374. doi: 10.1161/ STROKEAHA.115.011093.
25. Goyal M, Yu AY, Menon BK, Dippel D W, Hacke W, Davis S M et al. Endovascular therapy in acute isch- emic stroke: challenges and transition from trials to bedside. Stroke. 2016; 47: 548–553. doi: 10.1161/STROKEAHA.115.011426.
26. Demchuk AM, Menon BK, Goyal M. Comparing vessel imaging: non- contrast computed tomography/computed tomographic angiography should be the new minimum standard in acute disabling stroke. Stroke. 2016; 47: 273–281. doi: 10.1161/STROKEAHA.115.009171.
27. Goyal M, Hill MD, Saver JL, Fisher M. Challenges and opportunities of endovascular stroke therapy. Ann Neurol. 2016; 79: 11–17. doi: 10.1002/ ana.24528.
28. Ma H, Campbell BC, Parsons MW. Extending the time window for thrombolysis in emergency neurological deficits (EXTEND): high prevalence of intracranial vessel occlusion in wake-up stroke patients. Stroke. 2016; 47: A59.
29. Fisher M, Saver JL. Future directions of acute ischaemic stroke therapy. Lancet Neurol. 2015; 14: 758–767. doi: 10.1016/S1474-4422(15)00054-X.
30. Henninger N, Bratane BT, Bastan B, Bouley J, Fisher M. Normobaric hyperoxia and delayed tPA treatment in a rat embolic stroke model. J Cereb Blood Flow Metab. 2009; 29: 119–129. doi: 10.1038/jcbfm.2008.104.
31. Saver JL, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S et al. Prehospital use of magnesium sulfate as neuroprotection in acute stroke. N Engl J Med. 2015; 372: 528–536. doi: 10.1056/NEJMoa1408827.
32. Bråtane BT, Cui H, Cook DJ, Bouley J, Tymianski M, Fisher M. Neuroprotection by freezing ischemic penumbra evolution with- out cerebral blood flow augmentation with a postsynaptic den- sity-95 protein inhibitor. Stroke. 2011; 42: 3265–3270. doi: 10.1161/ STROKEAHA.111.618801.
33. Hougaard KD, Hjort N, Zeidler D, Sørensen L, Nørgaard A, Hansen T M et al. Remote ischemic perconditioning as an adjunct therapy to thrombolysis in patients with acute ischemic stroke: a randomized trial. Stroke. 2014; 45: 159–167. doi: 10.1161/ STROKEAHA.113.001346.
34. Hausenloy DJ, Yellon DM. Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J Clin Invest. 2013; 123: 92–100. doi: 10.1172/JCI62874.
35. Sanderson TH, Reynolds CA, Kumar R, Przyklenk K, Hüttemann M. Molecular mechanisms of ischemia-reperfusion injury in brain: pivotal role of the mitochondrial membrane potential in reactive oxy- gen species generation. Mol Neurobiol. 2013; 47: 9–23. doi: 10.1007/ s12035-012-8344-z.
36. Iadecola C, Anrather J. The immunology of stroke: from mechanisms to translation. Nat Med. 2011; 17: 796–808. doi: 10.1038/nm.2399.
37. Ribo M, Flores A, Rubiera M, Pagola J, Sargento-Freitas J, Rodriguez- Luna D et al.. Extending the time window for endovascular procedures according to collateral pial circulation. Stroke. 2011; 42: 3465–3469. doi: 10.1161/STROKEAHA.111.623827.
38. Bang OY, Goyal M, Liebeskind DS. Collateral Circulation in Ischemic Stroke: Assessment Tools and Therapeutic Strategies. Stroke. 2015; 46: 3302–3309. doi: 10.1161/STROKEAHA.115.010508.
39. ENOS Trial Investigators. Efficacy of nitric oxide with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomized controlled trial. Lancet. 2015; 385: 617–628. doi: 10.1016/S0140-6736(14)61121-1.
2. Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012;79:1781–1787. doi: 10.1212/ WNL.0b013e318270401d.
3. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah G A, Connor M, Bennett D A et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 383: 245–254.
4. Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014; 312: 259–268. doi: 10.1001/jama.2014.7692.
5. Towfighi A, Saver JL, Engelhardt R, Ovbiagele B. A midlife stroke surge among women in the United States. Neurology. 2007; 69: 1898–1904. doi: 10.1212/01.wnl.0000268491.89956.c2.
6. Puyal J, Ginet V, Clarke PG. Multiple interacting cell death mechanisms in the mediation of excitotoxicity and ischemic brain damage: a challenge for neuroprotection. Prog Neurobiol. 2013; 105: 24–48. doi: 10.1016/j. pneurobio.2013.03.002.
7. Moskowitz MA, Lo EH, Iadecola C. The science of stroke: mechanisms in search of treatments. Neuron. 2010; 67: 181–198. doi: 10.1016/j. neuron.2010.07.002.
8. Bardutzky J, Shen Q, Henninger N, Bouley J, Duong TQ, Fisher M. Differences in ischemic lesion evolution in different rat strains using diffusion and perfusion imaging. Stroke. 2005; 36: 2000–2005. doi: 10.1161/01. STR.0000177486.85508.4d.
9. Fisher M, Bastan B. Identifying and utilizing the ischemic penumbra. Neurology. 2012; 79: S79–S85. doi: 10.1212/WNL.0b013e3182695814.
10. Fisher M, Albers GW. Advanced imaging to extend the therapeutic time window of acute ischemic stroke. Ann Neurol. 2013; 73: 4–9. doi: 10.1002/ ana.23744.
11. Heiss WD. The ischemic penumbra: how does tissue injury evolve? Ann N Y Acad Sci. 2012; 1268: 26–34.
12. Goyal M, Menon BK, van Zwam WH, Dippel D W, Mitchell P J, Demchuk A M et al., HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta- analysis of individual patient data from five randomised trials. Lancet. 2016; 387: 1723–1731. doi: 10.1016/S0140-6736(16)00163-X.
13. Bracard S, Guillemin F, Ducrocq X. THRACE study: intermediate analysis results. Int J Stroke. 2015: 31.
14. Mocco J, Zaidat O, von Kummer R. Results of the THERAPY trial: a prospective, randomized trial to define the role of mechanical thrombectomy as adjunctive treatment to IV rtPA in acute ischemic stroke. Int J Stroke. 2015; 10: 10.
15. Meyers PM, Schumacher HC, Connolly ES Jr, Heyer EJ, Gray WA, Higashida RT. Current status of endovascular stroke treatment. Circulation. 2011; 123: 2591–2601. doi: 10.1161/CIRCULATIONAHA.110.971564.
16. Thomalla G, Gerloff C. Treatment concepts for wake-up stroke and stroke with unknown time of symptom onset. Stroke. 2015; 46: 2707–2713. doi: 10.1161/STROKEAHA.115.009701.
17. Lansberg MG, Straka M, Kemp S, Mlynash M., Wechsler L R, Jovin T G et al. DEFUSE 2 study investiga- tors. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012;11:860– 867. doi: 10.1016/S1474-4422(12)70203-X.
18. Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E et al. DEFUSE Investigators. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol. 2006; 60: 508–517. doi: 10.1002/ana.20976.
19. Trialists’Collaboration, Stroke Unit. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2013: 9(9). CD000197.
20. Gupta R, Horev A, Nguyen T, Gandhi D, Wisco D, Glenn B A et al. Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes. J Neurointerv Surg. 2013; 5: 294–297. doi: 10.1136/neurintsurg-2011-010245.
21. Southerland AM, Johnston KC, Molina CA, Selim MH, Kamal N, Goyal M. Suspected large vessel occlusion: should Emergency Medical Services transport to the nearest Primary Stroke Center or bypass to a Comprehensive Stroke Center with endovascular capabilities? Stroke. 2016; 47: 1965–1967. doi: 10.1161/STROKEAHA.115.011149.
22. Purrucker JC, Hametner C, Engelbrecht A, Bruckner T, Popp E, Poli S. Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort. J Neurol Neurosurg Psychiatry. 2015; 86: 1021–1028. doi: 10.1136/jnnp-2014-309260.
23. Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH. The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke. 2012; 43: 2078–2085. doi: 10.1161/ STROKEAHA.111.645861.
24. Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L et al. Benefits of stroke treatment using a mobile stroke unit compared with standard management: The BEST- MSU Study Run-In Phase. Stroke. 2015; 46: 3370–3374. doi: 10.1161/ STROKEAHA.115.011093.
25. Goyal M, Yu AY, Menon BK, Dippel D W, Hacke W, Davis S M et al. Endovascular therapy in acute isch- emic stroke: challenges and transition from trials to bedside. Stroke. 2016; 47: 548–553. doi: 10.1161/STROKEAHA.115.011426.
26. Demchuk AM, Menon BK, Goyal M. Comparing vessel imaging: non- contrast computed tomography/computed tomographic angiography should be the new minimum standard in acute disabling stroke. Stroke. 2016; 47: 273–281. doi: 10.1161/STROKEAHA.115.009171.
27. Goyal M, Hill MD, Saver JL, Fisher M. Challenges and opportunities of endovascular stroke therapy. Ann Neurol. 2016; 79: 11–17. doi: 10.1002/ ana.24528.
28. Ma H, Campbell BC, Parsons MW. Extending the time window for thrombolysis in emergency neurological deficits (EXTEND): high prevalence of intracranial vessel occlusion in wake-up stroke patients. Stroke. 2016; 47: A59.
29. Fisher M, Saver JL. Future directions of acute ischaemic stroke therapy. Lancet Neurol. 2015; 14: 758–767. doi: 10.1016/S1474-4422(15)00054-X.
30. Henninger N, Bratane BT, Bastan B, Bouley J, Fisher M. Normobaric hyperoxia and delayed tPA treatment in a rat embolic stroke model. J Cereb Blood Flow Metab. 2009; 29: 119–129. doi: 10.1038/jcbfm.2008.104.
31. Saver JL, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S et al. Prehospital use of magnesium sulfate as neuroprotection in acute stroke. N Engl J Med. 2015; 372: 528–536. doi: 10.1056/NEJMoa1408827.
32. Bråtane BT, Cui H, Cook DJ, Bouley J, Tymianski M, Fisher M. Neuroprotection by freezing ischemic penumbra evolution with- out cerebral blood flow augmentation with a postsynaptic den- sity-95 protein inhibitor. Stroke. 2011; 42: 3265–3270. doi: 10.1161/ STROKEAHA.111.618801.
33. Hougaard KD, Hjort N, Zeidler D, Sørensen L, Nørgaard A, Hansen T M et al. Remote ischemic perconditioning as an adjunct therapy to thrombolysis in patients with acute ischemic stroke: a randomized trial. Stroke. 2014; 45: 159–167. doi: 10.1161/ STROKEAHA.113.001346.
34. Hausenloy DJ, Yellon DM. Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J Clin Invest. 2013; 123: 92–100. doi: 10.1172/JCI62874.
35. Sanderson TH, Reynolds CA, Kumar R, Przyklenk K, Hüttemann M. Molecular mechanisms of ischemia-reperfusion injury in brain: pivotal role of the mitochondrial membrane potential in reactive oxy- gen species generation. Mol Neurobiol. 2013; 47: 9–23. doi: 10.1007/ s12035-012-8344-z.
36. Iadecola C, Anrather J. The immunology of stroke: from mechanisms to translation. Nat Med. 2011; 17: 796–808. doi: 10.1038/nm.2399.
37. Ribo M, Flores A, Rubiera M, Pagola J, Sargento-Freitas J, Rodriguez- Luna D et al.. Extending the time window for endovascular procedures according to collateral pial circulation. Stroke. 2011; 42: 3465–3469. doi: 10.1161/STROKEAHA.111.623827.
38. Bang OY, Goyal M, Liebeskind DS. Collateral Circulation in Ischemic Stroke: Assessment Tools and Therapeutic Strategies. Stroke. 2015; 46: 3302–3309. doi: 10.1161/STROKEAHA.115.010508.
39. ENOS Trial Investigators. Efficacy of nitric oxide with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomized controlled trial. Lancet. 2015; 385: 617–628. doi: 10.1016/S0140-6736(14)61121-1.