How to start a new era of cerebral infarction treatment?

 　　Intravascular mechanical thrombectomy is a more advanced treatment method for cerebral infarction, and the actual treatment effect is better. Therefore, it has been widely favored by scholars and doctors in the medical field. This marks the beginning of a new era of cerebral infarction treatment. However, in this process, patients still need to maintain an objective and clear understanding of this therapy in order to better protect their health.

　　1 open a new era of cerebral infarction - thrombectomy therapy

　　with the level of development and progress in medical technology, in the treatment of cerebral infarction, there is a more advanced treatment methods, namely "intravascular mechanical thrombectomy therapy." This therapy occupies a very high topic in the field of neuroscience. At the same time, a large number of clinical studies have also confirmed the effect of this therapy: patients with large blood vessel occlusion have adopted endovascular mechanical thrombectomy therapy, and more than 50% have been treated after treatment. Good recovery, able to return to society normally and start a new life. Before the introduction of mechanical endovascular thrombectomy therapy, it is hard to imagine that the treatment of cerebral infarction can achieve such a curative effect. It also proves that the emergence of mechanical thrombectomy therapy has successfully opened up a new approach in the treatment of cerebral infarction. era. The following is a brief introduction to intravascular mechanical thrombectomy therapy: The

　　so-called intravascular mechanical thrombectomy therapy is simply to puncture the patient’s femoral artery, and then use a microcatheter to put the thrombectomy device into the patient’s blood vessel , Driven by the blood, the thrombus removal device is sent to the occlusion position of the blood vessel, and then the thrombus in the blood vessel is smoothly removed by wrapping and adhesion of the thrombus removal device, and the human cerebrovascular channel is opened. Compared with traditional intravenous thrombolytic therapy, intravascular mechanical thrombectomy therapy is simpler and more direct. It can directly reach the lesion and eliminate the hidden danger of cerebral infarction from the root cause, that is, directly remove the emboli in the blood, so it can help the patient better recover Health, improve the treatment effect of cerebral infarction.

　　2 How to open a new era of cerebral infarction

　　due to the mechanical embolectomy Endovascular therapy has many advantages, many doctors have produced some extreme idea that traditional intravenous thrombolytic therapy is the "twilight", endovascular therapy is a mechanical thrombectomy " Kingly" Is this really the case? Although this therapy does have a good effect on patients with cerebral infarction, it is not suitable for all patients with cerebral infarction. This requires a clear understanding of the following:

　　On the one hand, intravascular mechanical thrombectomy therapy is only suitable for patients with large blood vessel occlusion. From the perspective of the principle of intravascular mechanical thrombectomy therapy, it mainly relies on thrombectomy devices to take the thrombus away from the blood vessel. However, due to the size of the thrombectomy device and the resolution of the DSA machine, the thrombectomy device can only work in large blood vessels and this therapy can be effective. Among patients with cerebral infarction, only about 30% of patients belong to large vessel occlusion, that is to say, this kind of mechanical endovascular thrombectomy therapy is only suitable for 30% of patients with cerebral infarction. In contrast to traditional intravenous thrombolytic therapy, in theory, as long as the blood can reach the place, intravenous thrombolysis can work, so it is suitable for almost all patients with cerebral infarction.

　　On the other hand, we also need to further understand which patients are suitable for endovascular mechanical thrombectomy and which patients are not suitable for this therapy.

　　In the latest "Guidelines for the Diagnosis and Treatment of Early Endovascular Intervention for Acute Ischemic Stroke in China 2018", the following situations of patients with cerebral infarction are proposed, which are suitable for choosing endovascular mechanical thrombectomy:

　　If the patient is due to the M1 segment of the cerebral artery and the neck Acute cerebral infarction caused by arterial occlusion. And before the onset of the patient, the mRS score is above 1 point, and the ASPECTS or NIHSS score is within 6 points, and the patient can choose to use arterial thrombus removal for the treatment of acute cerebral infarction. The mRS score is simply used to evaluate the ability of patients to recover brain nerve function after cerebral infarction. It is generally divided into seven grades. The higher the grade, the more difficult it is for patients to recover after cerebral infarction, and the disability rate is also Higher. ASPECTS is used to evaluate the changes of cerebral arterial blood supply in patients with early ischemia after acute cerebral infarction. Generally, the lower the score, the more serious the cerebral artery ischemia, and the more serious the consequences. NIHSS assesses the degree of damage to the brain nerves of a patient after the onset of cerebral infarction. Generally, the higher the score, the more serious the nerve damage will be and the greater the threat to life safety.

　　If the patient undergoes acute cerebral infarction, both intravenous thrombolytic therapy and arterial mechanical thrombectomy are suitable for treatment, then it is recommended to use intravenous thrombolysis for treatment first, and then cooperate with arterial mechanical thrombectomy for bridging treatment. It is recommended to directly use the arterial mechanical thrombectomy treatment method, because the arterial mechanical thrombectomy treatment is still a relatively new treatment method. The thrombolytic device is delivered to the lesion to achieve the corresponding effect. Therefore, it is still necessary to use intravenous thrombolysis to soften and reduce the patient’s thrombus, so that the follow-up is more conducive to the implementation of the arterial mechanical thrombectomy treatment method and improves The effect of the therapy. And for large vessel occlusion, intravenous thrombolysis is not completely useless. There is still a 17% probability of directly opening the patient's occluded large blood vessel. Therefore, if the arterial mechanical thrombolysis treatment is directly used, the patient may miss the best treatment opportunity .

　　If the location of the patient's cerebral infarction is the M2 segment of the anterior cerebral artery, vertebral artery, basilar artery, and middle cerebral artery, arterial thrombus removal can also be considered.

　　For patients with the following conditions, mechanical arterial thrombolysis is not recommended: (1) Patients with cerebral infarction have obvious active bleeding tendency; (2) Patients with severe heart, liver, and kidney dysfunction; (3) The patient's blood sugar is lower than 2.7 mmol/L, or the patient has diabetes, and the blood sugar is higher than 22.2 mmol/L; (4) The patient has severe hypertension.

　　3 Summary

　　In summary, the emergence of endovascular mechanical thrombectomy therapy, significantly enhance the therapeutic effect of cerebral infarction, patients recover better after treatment, it can be said to open a new era in the treatment of cerebral infarction. However, this treatment method still has certain limitations. It is not possible to directly ignore the advantages of traditional intravenous thrombolytic therapy because of the good treatment. We still need to improve our understanding and rationally use cerebral infarction treatment methods to achieve better treatment results.