International Circulation:  What are the top 5 findings or clinical trials in the last year that you think have had a tremendous impact on the stroke in the clinical practice? 

国际循环：您认为，在过去的一年中，哪项临床发现或试验结果对临床卒中工作的影响最大？

 

Prof. Gorelick:  The trial that has probably had the biggest impact is ECASS 3 which showed that we can extend the time window for intravenous rt-PA in acute ischemic stroke up to three or 4.5 hours.  This was done in a safe manner and it was effective and it will open up additional opportunities for acute ischemic stroke treatment.  It was also shown in studies that safety can be maintained.  The message however is that do not wait to treat your acute ischemic stroke – basically get them in before three to 4 and a half hour window nad try to treat them as soon as possible if they are eligible because TIME is BRAIN.

Prof. Gorelick：我认为对临床卒中工作影响最大的试验是ECASS-3。该试验结果显示，急性缺血性脑血管病静脉rt-PA溶栓的时间窗可以延长至3.0-4.5小时，同时证明这是一种安全、有效的方法。这一结果使得静脉TPA溶栓在急性缺血性脑血管病的治疗中得到更加广泛的应用。在急性缺血性脑血管病的治疗中，我们不能等待，我们不仅可以对时间窗为0-3小时之内的患者应用静脉TPA溶栓，而且，对于时间窗为3.0-4.5小时的患者，也可以使用静脉TPA溶栓，因为“时间就是大脑”。

 

International Circulation:  ECASS-3 showed that intravenous rt-PA thrombolytic therapy within 4.5 hours after symptom onset is safe and effective in treating patients with ischemic stroke. What kind of impact will this extended window of time have on the clinical practice?

国际循环：ECASS-3的试验结果显示，静脉rt-PA溶栓对于时间窗为4.5小时之内的急性缺血性脑血管病患者是安全、有效的。您认为，这一时间窗的延长，将对临床实践产生什么样的影响？

 

Prof. Gorelick:  It will give us that opportunity to treat more patients.  One of the biggest problems with TPA treatment is that they get beyond the three hour window.  Studies shows us that we can safely and effectively treat patients up to 4.5 hours but again the key message is do not wait.  Treat them sooner and get them treated.  TIME is BRAIN， each minute counts the longer we wait the less likely is the drugs will be effective though there is still statistical effectiveness or efficacy in this case up to 4.5 hours.

Prof. Gorelick：这将使我们能够有机会治疗更多的患者。急性缺血性脑血管病静脉rt-PA溶栓治疗存在的最大问题是，多数患者到达急诊室时已超过3小时的时间窗。既往研究提示，静脉rt-PA溶栓对于时间窗为4.5小时之内的患者是安全、有效的，而ECASS-3则通过出色的临床试验中证实了这一观点。但是关键仍在于不能等待。对于急性缺血性脑血管病患者，应尽可能快地给予治疗。 “时间就是大脑”，每一分钟都非常关键。尽管静脉TPA溶栓对于时间窗为4.5小时以内的患者都有效，但是等待的时间越长，药物的有效性就越差。

 

International Circulation:  What is the recent progress in the field of clot-retrieval devices? Do you think that it is a promising alternative for ischemic stroke patients who are not eligible for rt-PA thrombolysis?

国际循环：关于取栓器的最新进展是什么？对于不适于接受静脉rt-PA溶栓的急性缺血性脑血管病患者，您认为取栓器会是一种很有前途的替代治疗方法吗？

 

Prof. Gorelick:  Clot retrieval devices have increased our armamentarium for stroke treatment.  However just because you remove a clot does not mean that you are going to reprofuse the brain.  The inferior idea is that clot removal leads to recanalization of the artery and therefore reprofusion of the brain.  Sometimes however it does not work that way.  Fragments of the main clot break off into the circulation and clog up arteries distally you can not get them to reprofuse for that reason.  I think it is important to keep in mind that although the US FDA has approved clot retrieval devices and aspiration devices it does not mean that they are going to work in each case.  What it means is that they do what they says namely remove the clot either through mechanically or through an aspiration process.  They do it relatively safely but it does not mean that you will have efficacy.  I think we need to study efficacy in additional trials of clot retrieval devices and the Penumbra device which is an aspiration device and see if we can really achieve good patient outcome.

 

Prof. Gorelick：取栓器增加了脑卒中的治疗手段。然而，血块清除并不意味能够立即实现脑细胞再灌注。理论上，血块清除使动脉再通，从而可以实现脑细胞再灌注。但是有时候并不是这样的。在您试图清除血块时，血块可以破裂成多个碎片，这些小碎片随着血液循环流向并阻塞远端动脉，阻碍再灌注的发生。虽然FDA已经批准取栓器和吸栓器应用于急性缺血性脑血管病的治疗，但是这并不意味取栓器和吸栓器适用于每例患者。我认为这一点非常重要，大家需要牢记于心。取栓器和吸栓器能够安全地通过机械取栓或吸引设备清除血块，这是它们通过FDA批准的基础。但是这并不能保证它们的有效性。因此，我们需要进一步设计临床试验，研究取栓器和吸栓器的有效性，以保证这些治疗方法的有效性。

 

International Circulation:  Could you talk a little bit about where you see the direction of the treatment of ischemic stroke headed? What are some advances you are excited about?

国际循环：您认为缺血性脑血管病的治疗前景在哪儿，您能略微谈一下吗？哪些方面的发展令您感到兴奋？

 

Prof. Gorelick:  I think that one of the most important things in the treatment is to prevent stroke so we do not have to treat the patient as often.  If we can prevent strokes then we do not have to go through all this cost and disability and hardship on patient’s families so I think that we need to put more of our efforts into prevention.  Maybe control blood pressure better， we need to cut down or eradicate cigarette smoking， we need to reduce salt in the diet and promote other lifestyle factors to prevent stroke and to be a bit further along in terms of reducing stroke morbidity and mortality if we can prevent more strokes.  So I think that is the direction.

Gorelick教授：脑卒中治疗中最重要的一点在于预防，减少脑卒中的发生，这样我们所需要治疗的患者数目减少，卫生保健系统的医疗成本下降，患者和家庭的负担也减轻。我认为我们需要把更多的精力投入预防工作中。我们可以更好地控制血压，减少或戒除吸烟，减少饮食中盐的摄取，并促进其他生活方式的改进，以更好地预防脑卒中。