kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2022-11-3-188-198kpccz-1173Research ArticleОНЛАЙН. АНАЛИТИЧЕСКИЙ ОБЗОР. Сердечно-сосудистая хирургияONLINE. REVIEW. Cardiovascular surgeryЭндоваскулярные методы лечения ишемического инсультаEndovascular treatments for ischemic strokehttps://orcid.org/0000-0001-6032-788XМалаевД. У.MalaevD. U.

Малаев Дастан Урматович - врач по рентгенэндоваскулярным диагностике и лечению.

ул. Немировича-Данченко, 130, Новосибирск, 630087.

Dastan U. Malaev - Specialist in Endovascular Diagnostics and Treatment at the State Novosibirsk Regional Clinical Hospital.

130, St. Nemirovich-Danchenko, Novosibirsk, 630087.

dastan.kgma@gmail.comhttps://orcid.org/0000-0001-6100-3625ГрачевН. И.GrachevN. I.

Грачев Никита Игоревич - кандидат медицинских наук врач по рентгенэндоваскулярным диагностике и лечению.

ул. Алеутская, 57, Владивосток, 690091.

Nikita I. Grachev - PhD, Specialist in Endovascular Diagnostics and Treatment at the Primorsk Regional Clinical Hospital № 1.

57, Aleutskaya St., Vladivostok, 690091.

https://orcid.org/0000-0001-7796-8405РедькинД. А.RedkinD. A.

Редькин Дмитрий Анатольевич - врач по рентгенэндоваскулярным диагностике и лечению.

ул. Немировича-Данченко, 130, Новосибирск, 630087.

Dmitry A. Redkin - Specialist in Endovascular Diagnostics and Treatment at the State Novosibirsk Regional Clinical Hospital.

130, St. Nemirovich-Danchenko, Novosibirsk, 630087.

Государственная Новосибирская областная клиническая больницаРоссияState Novosibirsk Regional Clinical HospitalRussian FederationПриморская краевая клиническая больница № 1РоссияPrimorsk Regional Clinical Hospital № 1Russian Federation202212102022113188198Copyright © Малаев Д.У., Грачев Н.И., Редькин Д.А., 20222022Малаев Д.У., Грачев Н.И., Редькин Д.А.Malaev D.U., Grachev N.I., Redkin D.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/1173Основные положения

Основные положения. Механическая тромбэкстракция – «золотой стандарт» лечения пациентов с окклюзией крупных церебральных артерий. Значительный вклад в развитие и внедрение в клиническую практику механической тромбэкстракции внесли пять рандомизированных исследований, проведенных в 2015 г. Исследования DAWN и DEFUSE 3 открыли новое понимание патофизиологии ишемического инсульта и расширения терапевтического окна.

Резюме

Резюме. Инсульт – одна из главных причин смертности и инвалидизации населения во всем мире. Общая стратегия терапевтических мер при ишемическом инсульте направлена на восстановление кровотока в ишемизированные отделы головного мозга. С 1996 г. внутривенная тромболитическая терапия была первой линией лечения больных ишемическим инсультом. Однако с 2015 г. на основании результатов пяти рандомизированных исследований «золотым стандартом» лечения пациентов с окклюзией крупных церебральных артерий стала эндоваскулярная механическая тромбэкстракция. Исследования DAWN и DEFUSE 3 способствовали новому пониманию патофизиологии ишемического инсульта со сменой парадигмы «время – мозг» на «коллатерали – мозг». В данной статье проанализированы этапы развития эндоваскулярных устройств, современные техники механической тромбэкстракции, а также возможные направления дальнейшего исследования эндоваскулярных методов лечения ишемического инсульта.

Highlights

Highlights. Mechanical thrombectomy is the “gold standard” treatment of patients with large-vessel occlusions. Five randomized trials conducted in 2015 made a significant contribution to the development and introduction of mechanical thrombectomy into clinical practice. The DAWN and DEFUSE-3 trials have provided new insights into the pathophysiology of ischemic stroke and ensured the advancement in the therapeutic field.

Abstract

Abstract. Stroke is one of the leading causes of death and disability worldwide. The general strategy for the treatment of ischemic stroke is aimed at restoring blood flow to the ischemic regions of the brain. Intravenous thrombolysis has been the treatment for acute ischemic stroke since 1996. However, since 2015, as a result of 5 randomized trials, endovascular mechanical thrombectomy has become the gold standard for the treatment of patients with large cerebral artery occlusion. The DAWN and DEFUSE 3 trials have provided new insights into the pathophysiology of ischemic stroke, shifting the paradigm from “time = brain” to “collaterals = brain”. In this article, the authors will consider development of endovascular devices, modern mechanical thrombectomy techniques, and directions for further research of endovascular treatment for ischemic stroke.

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The authors declare that there are no conflicts of interest present.