nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2014-3-61-68nnp-439Research ArticleREVIEWSОБЗОРЫFactors influencing the efficiency and safety of systemic thrombolysis in patients with ischemic strokeФакторы, влияющие на эффективность и безопасность системного тромболизиса у пациентов с ишемическим инсультомШамаловН. А.ShamalovN. A.

117997, Москва, ул. Островитянова, 1

1, Ostrovityanov St., Moscow 117997

1, Ostrovityanov St., Moscow 117997

АнисимовК. В.AnisimovK. V.

117997, Москва, ул. Островитянова, 1

1, Ostrovityanov St., Moscow 117997

КустоваМ. А.KustovaM. A.

117997, Москва, ул. Островитянова, 1

1, Ostrovityanov St., Moscow 117997

ТолмачевА. П.TolmachevA. P.

117997, Москва, ул. Островитянова, 1

1, Ostrovityanov St., Moscow 117997

НИИ цереброваскулярной патологии и инсульта ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России Кафедра фундаментальной и клинической неврологии и нейрохирургии ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияResearch Institute of Cerebrovascular Pathology and Stroke N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia Department of Fundamental and Clinical Neurology and Neurosurgery, N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationНИИ цереброваскулярной патологии и инсульта ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияResearch Institute of Cerebrovascular Pathology and Stroke N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationКафедра фундаментальной и клинической неврологии и нейрохирургии ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияDepartment of Fundamental and Clinical Neurology and Neurosurgery, N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian Federation201423102014636168Copyright © Shamalov N.A., Anisimov K.V., Kustova M.A., Tolmachev A.P., 20142014Шамалов Н.А., Анисимов К.В., Кустова М.А., Толмачев А.П.Shamalov N.A., Anisimov K.V., Kustova M.A., Tolmachev A.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/439

Systemic thrombolysis using recombinant tissue plasminogen activator is the most effective and safe therapy option for ischemic stroke (IS) in the first 4.5 hours after onset of the disease. The safety and efficiency (or inefficiency) of perfusion therapy in patients with IS may be affected by a multitude of factors associated with the time of the therapy, patient age, the presence and size of a brain region with potentially reversible changes, the location of a cerebral lesion region, the specific features of systemic and local hemodynamics, and the degree of blood-brain barrier impairment. The hemorrhagic transformation of a brain lesion focus in IS is a serious complication of thrombolytic therapy (TT). The analysis and detection of predictors for hemorrhagic complications, TT in terms of the clinical and pathogenetic features of the disease, the location of a lesion focus and the degree of early neuroimaging signs, and data of additional studies will contribute to the safer and more effectiveuse of this treatment in patients with IS.

Системный тромболизис с использованием рекомбинантного тканевого активатора плазминогена (rt-PA) является наиболее эффективным и безопасным методом терапии при ишемическом инсульте (ИИ) в первые 4,5 ч от начала развития заболевания. На безопасность и эффективность (или отсутствие таковой) реперфузионной терапии у больных с ИИ могут оказывать влияние множество факторов, связанных со временем начала ее проведения, возрастом больного, наличием и размером области мозга с потенциально обратимыми изменениями, локализацией очага поражения мозга, особенностями системной локальной гемодинамики, степенью повреждения гематоэнцефалического барьера. Геморрагическая трансформация очага поражения головного мозга при ИИ является серьезным осложнением тромболитической терапии (ТЛТ). Анализ и выявление предикторов геморрагических осложнений, проведение ТЛТ с учетом клинико-патогенетических особенностей заболевания, локализации очага поражения и степени выраженности ранних нейровизуализационных признаков, данных дополнительных методов исследования будут способствовать более безопасному и эффективному применению данного метода лечения у пациентов с ИИ.

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