PDF(Pubmed)
Abstract：
Stroke is the second most common cause of death worldwide, with 50% of survivors experiencing long-term disability. For more than two decades, treatment with intravenous thrombolysis (IVT) and mechanical endovascular thrombectomy (MET), the only approved stroke reperfusion therapies, was restricted to patients within the 4.5-6 hour time window, respectively. Therefore, patients who presented with acute ischemic stroke (AIS) beyond the conventional time window were excluded from reperfusion treatment. This narrative review aims to review the scientific literature on the possibilities of reperfusion therapies for patients who present with an unknown time of stroke onset, and those with stroke onset beyond the conventional 4.5-6 hour time window. Beyond the conventional time window, the eligibility of patients for IVT or MET, the two main therapeutic procedures, is decided based on the concept of penumbral imaging. Penumbral imaging identifies patients with hypoperfused but viable brain tissue, who could benefit from reperfusion. On the other hand, clock-based DWI-fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) can detect stroke that has occurred within 4.5 hours in patients with an unknown time of onset, including patients who awaken with stroke. The introduction of penumbral imaging and MRI-based tissue clocking as imaging biomarkers for stroke has revolutionized stroke therapy, potentially allowing for personalized treatment of eligible stroke patients.
摘要：
中风是全球第二大常见死因，50%的幸存者经历长期残疾。二十多年来,静脉溶栓（IVT）和机械血管内血栓切除术（MET），唯一被批准的中风再灌注疗法，仅限于4.5-6小时时间窗口内的患者，分别。因此,超过常规时间窗出现急性缺血性卒中(AIS)的患者被排除在再灌注治疗之外.这篇叙述性综述旨在回顾有关中风发作时间未知的患者再灌注治疗可能性的科学文献。以及中风发作超过常规4.5-6小时时间窗的患者。在传统的时间窗口之外，患者接受IVT或MET的资格，两个主要的治疗程序，是基于半影成像的概念决定的。半影成像可识别灌注不足但仍存活的脑组织患者，谁可以从再灌注中受益。另一方面,基于时钟的DWI-液体衰减反转恢复（FLAIR）磁共振成像（MRI）可以检测发病时间未知的患者在4.5小时内发生的中风，包括中风患者。半影成像和基于MRI的组织时钟作为中风的成像生物标志物的引入彻底改变了中风治疗。可能允许对符合条件的卒中患者进行个性化治疗。
