中等血管闭塞性缺血性卒中再灌注治疗的研究进展及展望

doi:10.3969/j.issn.1673-5765.2025.11.013

摘要/Abstract

摘要： 中等血管闭塞（medium vessel occlusion，MeVO）性缺血性卒中的再灌注治疗策略选择目前尚存在争议，该方向也是近年来脑血管疾病诊疗领域的研究热点。本文综合介绍了MeVO再灌注治疗相关研究的最新进展。目前研究证据显示，血管内治疗对MeVO性缺血性卒中的疗效有限，且可能增加安全性风险。相比之下，静脉溶栓因具有良好的血管再通率与临床可及性优势，展现出了较大的治疗潜力，但目前缺乏高级别循证证据支持其疗效与安全性。本文总结了当前MeVO再灌注治疗临床研究设计的局限性，分析了血管内治疗相关研究多呈现阴性结局的原因，并汇总了多项正在进行的临床研究动态，旨在为明确MeVO的精准治疗路径与未来研究方向提供参考。

文章导读： 目前在MeVO性缺血性卒中的再灌注治疗领域，不论是静脉溶栓、EVT还是桥接溶栓等治疗策略，均缺少明确获益的证据。对目前研究结果进行深入分析发现，在特定的患者人群中，再灌注治疗具有更明显的获益趋势。后续研究应重点探索可从再灌注治疗中获益的患者群体、更科学的治疗策略，以及开发先进的辅助诊疗技术。

关键词: 中等血管闭塞; 急性缺血性卒中; 血管内治疗; 静脉溶栓

Abstract: Ischemic stroke caused by medium vessel occlusion (MeVO) has emerged as a research hotspot in the field of cerebrovascular disease diagnosis and treatment in recent years, yet the choice of reperfusion therapy strategy remains controversial. This article provides a comprehensive review of the latest advances in research related to reperfusion therapy for MeVO. Current evidence indicates that endovascular treatment has limited efficacy in MeVO patients and may increase safety risks. In contrast, intravenous thrombolysis has shown considerable therapeutic potential due to its favorable vascular recanalization rate and clinical accessibility, but it still lacks high-level evidence regarding its efficacy and safety. This article summarizes the limitations of current clinical trial designs for MeVO reperfusion therapy, analyzes the reasons why most endovascular treatment trials have yielded negative outcomes, and compiles updates on several ongoing clinical trials. It aims to provide a reference for clarifying the precise treatment pathway and future research directions for MeVO.

Key words: Medium vessel occlusion; Acute ischemic stroke; Endovascular treatment; Intravenous thrombolysis

中图分类号:

马宇洁, 王利圆, 熊云云. 中等血管闭塞性缺血性卒中再灌注治疗的研究进展及展望[J]. 中国卒中杂志, 2025, 20(11): 1460-1470.

MA Yujie, WANG Liyuan, XIONG Yunyun. Advances and Future Directions in Reperfusion Therapy for Medium Vessel Occlusion Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(11): 1460-1470.

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