缺血性卒中血管内治疗后时代：反桥接动脉溶栓研究进展（Research Progress on the Effect of Intra-Arterial Thrombolysis on Improving Functional Outcomes Following Successful Endovascular Treatment）

血管内治疗作为急性大血管闭塞性缺血性卒中的一线治疗措施，能实现80%以上的血管再通率。但血管内治疗后无效再通问题突出，约50%的患者无法获得良好功能预后。无复流现象和早期动脉再闭塞是血管内治疗后无效再通的核心机制，且两者均与术后血栓负荷密切相关。血管内治疗反桥接动脉溶栓可清除残余血栓并改善脑组织的微循环灌注，有望进一步改善急性大血管闭塞性缺血性卒中患者的功能预后。2022年，机械取栓治疗急性卒中血栓栓塞药物优化（chemical optimization of cerebral embolectomy in patients with acute stroke treated with mechanical thrombectomy，CHOICE）研究结果公布后，多项探索血管内治疗反桥接动脉溶栓有效性及溶栓药物最佳剂量的研究相继开展。然而，由于不同研究的关键设计要素存在差异，其结果具有明显的异质性。本文对血管内治疗后反桥接动脉溶栓相关研究进展进行综述，探讨该治疗技术改善急性大血管闭塞性缺血性卒中患者功能预后的潜在价值，以期为临床医师和研究者提供治疗决策参考和相关研究设计思路。Abstract: Endovascular treatment, as the first-line treatment for acute ischemic stroke with large vessel occlusion, achieves a successful recanalization rate of over 80%, yet half failed to achieve good functional outcome at 90 days, indicating the prevalence of futile recanalization. No-reflow phenomenon and early arterial reocclusion, both closely associated with post-procedural thrombotic burden, are the core mechanisms underlying futile recanalization after endovascular treatment. Intra-arterial thrombolysis after endovascular treatment can clear residual thrombi and improve microcirculatory perfusion in brain tissue, holding promise for further enhancing functional outcomes in acute ischemic stroke with large vessel occlusion patients. In 2022, after the publication of the chemical optimization of cerebral embolectomy in patients with acute stroke treated with mechanical thrombectomy (CHOICE) trial, subsequent studies exploring the efficacy of intra-arterial thrombolysis after endovascular treatment or the optimal dosage of thrombolytic agents have been initiated. However, due to differences in key design elements across these studies, their results exhibit significant heterogeneity. This article reviews the research progress on intra-arterial thrombolysis after endovascular treatment, discusses its potential value in improving the functional outcomes of patients with acute ischemic stroke with large vessel occlusion, and aims to provide clinicians and researchers with a reference for clinical decision-making and insights for relevant research design.