- 期刊
2023台灣腦中風學會急性缺血中風動脈內血栓移除治療指引更新
2023 Update to the Taiwan Stroke Society Guidelines for Endovascular Thrombectomy in Acute Ischemic Stroke Patients
摘要
動脈內血栓移除治療（Endovascular thrombectomy, EVT）是急性缺血性腦中風合併大動脈阻塞之標準治療之一。隨著近年增加的許多研究實證，動脈內血栓移除治療的適應症逐漸放寬。本學會和台灣神經血管外科與介入治療醫學會組成指引共識小組，針對EVT的進展，將2019年發表的急性缺血中風動脈內血栓移除治療指引進行更新。本共識小組成員包含神經內科、神經放射科、神經外科、麻醉科等專家，由各章節作者完成初稿後，招開多次共識會議，根據最新的文獻證據，針對各個議題產出建議。本指引含蓋了五個近年有顯著進展的主題：（1）動脈內血栓移除術前影像檢查；（2）靜脈血栓溶解劑治療在血栓移除治療時的角色；（3）前循環腦中風6-24小時內血栓移除治療；（4）後循環腦中風之血栓移除治療；（5）血栓移除術中之鎮靜與麻醉。本指引經專家審查，提供台灣健保署擴大給付腦中風24小時內血栓移除治療，讓更多的急性缺血性中風病人能接受適當的再灌流治療受益。
關鍵字
無資料並列摘要
Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke with large vessel occlusion. American Herat Association/American Stroke Association and Taiwan Stroke Society published the 2019 guidelines of EVT management for acute ischemic stroke patients, which provided evidence-based recommendations for clinical physicians. Recently, a growing number of studies have investigated treatment dilemmas in EVT for patients with late-presenting stroke 6-24 hours from onset, large infarct cores 50-100 ml, and posterior circulation stroke. However, the recommendations for these issues have not been updated yet after 2019. Therefore, Taiwan Stroke Society and Taiwan Society for Neurovascular and Interventional Surgery organized the guideline consensus group to focus on the updated EVT guidelines on the aforementioned progress. The guidelines cover five sections, including (1) imaging examination before EVT, (2) intravenous thrombolysis in the era of EVT, (3) EVT for anterior circulation stroke in 6-24 hours from onset, (4) EVT for posterior circulation stroke, (5) anesthesia and sedation for EVT. The guideline consensus group developed recommendations via consensus meetings based on reviewed evidences. Each proposed class of recommendation and level of evidence was approved by the group members. The guideline was reviewed by the Society's committee experts, providing the Taiwan National Health Insurance Agency with evidence to extend the EVT reimbursement within 24 hours of stroke and benefit more acute ischemic stroke patients with appropriate reperfusion therapy.