*僅供醫(yī)學(xué)專業(yè)人士閱讀參考

ESOC震撼發(fā)布：急性缺血性卒中靜脈溶栓迎來多項(xiàng)證據(jù)，破解臨床難題！

本期要點(diǎn)

近年來，急性缺血性卒中（ AIS）領(lǐng)域進(jìn)展顯著，替奈普酶作為一種新型纖溶酶原激活物，近年來已成為再灌注治療領(lǐng)域的研究熱點(diǎn)。然而，在特殊人群和特殊場(chǎng)景下，靜脈溶栓仍有許多未解決的臨床問題。近期舉辦的2025年ESOC大會(huì)圍繞臨床未滿足需求，帶來了多項(xiàng)研究成果，以下為亮點(diǎn)速覽：

• 橋接治療：對(duì)于急性前循環(huán)大血管閉塞缺血性卒中，一項(xiàng)多中心登記研究顯示，原研替奈普酶橋接機(jī)械取栓治療可顯著改善3個(gè)月功能預(yù)后，且這一改善不受預(yù)期治療時(shí)間影響；對(duì)于急性后循環(huán)大血管閉塞缺血性卒中，登記研究和薈萃分析顯示，橋接治療較直接取栓，3個(gè)月功能預(yù)后更優(yōu)，且不增加癥狀性顱內(nèi)出血發(fā)生風(fēng)險(xiǎn)；對(duì)基底動(dòng)脈閉塞（BAO）患者而言，多中心隊(duì)列研究顯示，單獨(dú)靜脈溶栓較取栓聯(lián)合或不聯(lián)合靜脈溶栓，臨床結(jié)局更優(yōu)。

• 輕型卒中：一項(xiàng)登記研究分析顯示，對(duì)于輕型卒中患者，相較于非靜脈溶栓，靜脈溶栓治療與良好的3個(gè)月功能結(jié)局顯著相關(guān)，且兩組死亡率無顯著差異。ORIGINAL研究亞組分析顯示，原研替奈普酶治療致殘性輕型卒中療效和安全性與阿替普酶相似。

• 超窗治療：多項(xiàng)研究支持超時(shí)間窗（＞4.5h）靜脈溶栓治療仍可為患者帶來獲益。

*以下內(nèi)容僅供在中國大陸執(zhí)業(yè)的

醫(yī)療衛(wèi)生專業(yè)人士瀏覽。

參考文獻(xiàn)：

[1]Majoie CB, et al. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet. 2023;402(10406):965-974.

[2]Kaesmacher J, et al. Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke: A Meta-Analysis. JAMA. 2024;331(9):764-777.

[3]Gaspard Gerschenfeld. Time to treatment with IV Tenecteplasebefore thrombectomy and functional outcome in stroke. 2025 ESOC.

[4]Ilbena Rama, et al. Effect of external intravenous thrombolysis on intracranial large vessel occlusion in patients transferred from external hospitals for endovascular thrombectomy. 2025 ESOC.

[5]Silija Raty, et al. Intravenous thrombolysis versus endovascular thrombectomy in acute basilar artery occlusion-a multicentre cohort study. 2025 ESOC.

[6]Chih-hao Chen, et al. Bridging or direct thrombectomy in posterior circulation Large-Vessel Occlusion stroke: analysis of Taiwan and Korea nationwide registries and meta-analysis. 2025 ESOC.

[7]R. pop, et al. Intravenous thrombolysis before endovascular treatment in acute vertebrobasilar occlusions: pooled analysis of the French and German stroke registries. 2025 ESOC.

[8]中華醫(yī)學(xué)會(huì)神經(jīng)病學(xué)分會(huì),等. 輕型卒中臨床診療中國專家共識(shí)（2024版）. 中華神經(jīng)科雜志,2025,58(05)：462-474.

[9]K. Kristensen, et al. Functional outcomes of thrombolysis versus no thrombolysis in patients with mild ischemic stroke. A comparative effectiveness study. 2025 ESOC.

[10]Shuya Li, et al. Tenecteplase versus alteplase for patients with minor acute ischemic stroke: An analysis of the ORIGINAL study.2025 ESOC.

[11]Cristina del Vall-Vargas, et al. Use of intravenous thrombolysis in extended time window, with or without thrombectomy, for acute ischemic stroke: a multicenter study in Catalonia.2025 ESOC.

[12]Jero Esplanada, et al. What are the outcomes for adult survivors of acute ischemic stroke who received thrombolysis after 4.5 hours from onset? 2025 ESOC.

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審批編號(hào)：SC-CN-16790 有效期至：2026年5月29日

*此文僅用于向醫(yī)學(xué)人士提供科學(xué)信息，不代表本平臺(tái)觀點(diǎn)