中风治疗，时间就是一切。近20年来，一个药物组织型纤溶酶原激活剂（tPA）都具有一个被治疗的谁吃亏的人的黄金标准急性缺血性中风。
通常情况下，越早tPA的启动，更好的病人的效果会。但只有约8谁在抵达医院的中风患者％的有资格的tPA。即使患者在治疗窗内到达，tPA的并不总是最好的治疗方法。在大约一个小时的过程中静脉内递送，tPA的并不总是有效地溶解在主要动脉，其中最严重和衰弱类型的中风源自血块。
Endovascular therapy: A viable option?
因为tPA的使用限制的，需要选择这种治疗。几十年来，研究人员一直在研究血管内治疗来治疗中风。到现在为止，血管内治疗临床试验的结果有好有坏，但许多中风专家的失望。
But the results reported in 2015 from five significant international trials (most funded by makers of the devices used in the intervention) have shown that aspects of the technique have improved enough to consider the therapy a major player in future stroke treatment, especially for severe and potentially disabling strokes.
在血管内治疗，通常被称为动脉内治疗，神经血管外科医生将导管插入患者的腹股沟切口，它穿线到阻止血管。
一种支架检索，或stentriever，这是连接到导管的装置，抓住凝块，并且外科医生拉动它通过切口。进行血管内治疗的tPA前通常静脉内给药。该过程的变型，但是，通过所述导管并直接进入凝块提供的tPA。
The intervention works best on large blood clots in major arteries, called large vessel occlusions (LVOs), which cause the most severe strokes. In the latest clinical continued trials, the degree to which patients could regain function and independence at 90 days after interventions was consistently better among patients treated with endovascular therapy, usually combined with tPA, than in patients treated with intravenous tPA alone.
死亡率分别为血管内治疗组中较低。并发症，如脑出血，两组罕见。研究人员剪短一些，因为血管内治疗的精心挑选的患者阳性结果的试验。
与TPA，时间保持在血管内治疗的关键要素。外科医生必须在6小时内中风发作后多用tPA的执行过程中，一个稍长的时间窗口。
Advanced techniques
最新一轮的临床试验已造成超过失望批量试验，结束最近在2013年的第一个最近的试验中的更好的结果，荷兰的研究形象地称为MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), involved patients who were within six hours of stroke onset.
几乎所有的患者接受静脉注射tPA和随后分配到常规治疗或进一步干预血管内治疗。这些谁收到的血管内治疗有三个月后自己的能力，以功能显著增加，无脑出血的证据和死亡率没有增加。
One key to the latest success of endovascular therapy is likely the improvement in imaging technology that’s used to select patients who’ll benefit from the procedure.
治疗中风的第一步是识别中风的患者是有，无论是缺血性或出血的类型，使用计算机断层摄影（CT）扫描或与血管造影CT扫描。出血性中风患者不能用tPA的或血管内治疗，这可能会导致更多的脑损伤进行治疗。
CT扫描还可以揭示凝块的大小和位置，并在脑损伤的程度。用于血管内治疗的最佳候选是那些具有一个LVO和有限的损伤脑组织中称为半影大脑的一个区域。如果出现在CT扫描显著损害，为时已晚以进行治疗。
Most of the studies used basic imaging and some form of imaging of the blood vessels: CT with angiography, MRI with angiography or studies called perfusion imaging, which accurately show how much blood is getting to the brain.
Another reason for better outcomes, according to experts, is the introduction of improved clot-busting mechanical devices like stentrievers used in endovascular therapy. These devices entrap and remove clots, restoring blood flow.
像的Merci猎犬，其诱捕具有螺旋状形状的装置中的凝块和半影系统，它使用一个真空顶端以除去凝块第一代设备，已通过更新，更快和更可靠的在很大程度上代替金属丝网stentrievers像接龙和Trevo。
Though tPA continues to be the optimal initial treatment for ischemic stroke, the American Heart Association/American Stroke Association also recommends stent retrieval device for certain patients experiencing acute ischemic stroke, including patients who:
•Had no significant disability before the current stroke
•4.5小时症状，发病时间内接受的tPA
•有血块阻塞大动脉的血液供应到大脑
•已年满18岁
•Experienced an acute, severe stroke
•Have no permanent damage in more than half the brain on the affected side
•Can have the procedure start within six hours after symptom onset
The response time to treat stroke victims has improved in recent years as well. The benefits of tPA and endovascular surgery depend on the time it takes to treat a stroke. The heightened awareness of the need for fast-acting treatment by emergency responders and clinicians has made endovascular therapy a more viable alternative.
The ideal “door-to-needle” time—the time from which a stroke patient enters the hospital, is evaluated and tPA administered—is 60 minutes or less. This rapid response should also benefit endovascular therapy results.
壁垒血管内治疗
A major benefit of endovascular therapy is that it can extend the therapeutic window for patients who arrive at the hospital too late for tPA. Yet, if endovascular therapy sounds too good to be true, it may be, at least for now.
很少有美国医院都配备执行该程序。外科医生必须在血管内治疗是经过专门训练，并为治疗方案必须得到发展。在大多数情况下，干预是目前在临床试验中参加了卒中中心提供。它也是在教学市区医院比其他地区应用较多。
一种策略的一些应急服务使用的是要解决血管内治疗的参差不齐的可用性是让中风患者送往就近医院的四和一个半小时的时间框架内提供的tPA。一旦患者被评估和tPA的管理，他或她可以安全地运送到可以进行血管内治疗中风中心。
Learn more about unique stroke risk factors,including stroke risk factors for women和那些与atrial fibrillation (Afib)以及如何识别中风的迹象。。