並列摘要
Through the past decades, the development of rt-PA and endovascular thrombectomy provides patients a better chance having a better outcome. However, in malignant middle cerebral artery (MCA) infarction, the mortality and morbidity rate remain still high due to massive brain tissue injury leading to subsequent brain swelling and potential herniation. Conservative treatment shows no obvious efficacy. Currently, the established treatment is still mainly surgical intervention, including decompressive craniectomy and strokectomy. Nevertheless, there are many ongoing studies aiming to reverse the outcome. Glibenclamide inhibiting the SUR1 to prevent brain oedema showed a better outcome in comparison to decompressive craniectomy in animal model. Its safety was established in phase 1 and phase 2 trials. A phase 3 trial is currently ongoing (CHARM trial). The trial focusing on those patients with large territory infarction (80- 300ml) within 10 hours of onset. These data may further provide us a new treatment selection for those patients with malignant MCA infarctions.
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