IC: Where do you imagine the research going to overcome some of these challenges?
《国际循环》：您认为克服这些挑战的研究有哪些？
Dr. Liebeskind: It will take a little while， but we will be looking from an endovascular stroke trial perspective at step-wise approaches， that is， understanding how far to go and when to call it quits in a case. Oddly enough， this is dependent on us， that we are willing to know when to call it quits. Especially in patients with malignant patterns， we need to be able to say that we are not going to treat these patients. It is a real challenge. We want to do something for these patients.
Dr. Liebeskind: 这需要一定的时间，但是我们将会用分步治疗法从血管内中风试验的方面来研究，也就是，理解一个病例会进展到何种程度并在何时放弃治疗。奇怪的是，这依赖于我们自己，我们正试图了解什么时候应放弃治疗。特别是对于那些病情严重的患者，我们需要对患者家属说出我们将不再治疗这些患者的话。这是一个真正的挑战。我们想为这些患者做些事情。
IC: Does this rely on the imaging?
《国际循环》：这些是否依赖于影像学的结果？
Dr. Liebeskind: If you have an imaging pattern that suggests a malignant course， we may want to do something， but our ultimate outcome may be modest.
Dr. Liebeskind: 如果患者的影像学结果表明情况很严重，我们可能希望做一些事情，但是我们最终的结果可能并不乐观。
IC: Your talk emphasized the importance of collaterals in stroke therapy. What kind of research supports this opinion?
《国际循环》：您的演讲中强调了侧支血管在中风治疗中的重要性，有哪些支持这些观点的研究？
Dr. Liebeskind: Paradoxically， the entire literature on blood flow in the brain started with collateral flow， rather than arterial occlusions. The recognition， especially using angiography， that arterial occlusion was a cause of stroke was only defined decades ago. The understanding of flow is much older than that， centuries old. The recent advances have been in the forms of complimentary imaging， such as CT and MRI. We use multimodal approaches to compliment our angiographic studies to define where these collaterals are and to look at the resultant downstream perfusion. You have to define where this data comes from. When you are speaking about collateral perfusion， if you have an MCA occlusion， the flow in the territory is all via collaterals， so all profusion studies， whether a CT， MRI， PET， or any nuclear study will be of collaterals. That may be different with stenosis or a submaximal occlusion. When we talk about flow， when we talk about salvageable tissue， when we talk about mismatch， these are all new terminology for collateral sustenance of the brain. Only certain groups have been involved in the specific research and evidence in terms of collaterals， though the interest has been mounting very quickly in the last several years. The more people look at collaterals， the more people are appreciating this and starting to take heed and consider them in terms of outcomes.
Dr. Liebeskind: 自相矛盾的是，关于大脑血流的所有文献都开始于侧枝循环，而不是动脉闭塞。动脉闭塞是引起中风的原因只是在十几年前定义的，这种认识尤其是通过血管造影术得到的。而对血流的认识比这一观点要古老很多，有百年的历史。最近的进展是在互补成像方面，比如CT和MRI。我们应用了多模式的方法来完成我们的血管造影研究，来阐明这些侧枝循环在哪里并了解它们下游的灌注情况。你需要明确这些数据的来源。当你谈到侧枝循环灌注的时候，如果你发生了MCA闭塞，病变部位的血流完全通过侧枝循环，因此所有的研究，不论是CT，MRI，PET或任何核素研究都将是关于侧枝循环的。这时研究狭窄或亚极量闭塞将很困难。当我们谈到血流的时候，当我们谈到未梗死组织时，当我们谈到失配，这些都是用于描述维持大脑的侧枝循环的新术语。只有特定的组被纳入了特定的研究并确定为侧枝循环，这一研究领域最近几年里发展非常迅速。人们对侧枝循环的研究越多，对它的了解就越多，就会开始关注侧枝循环并认识到它是一种结果。
IC: You mentioned angiogenesis in your talk. What is the time frame for this?
《国际循环》：您在演讲中谈到了血管生成。请问血管生成大概需要多久？
Dr. Liebeskind: Angiogenesis， more specifically arteriogenesis， takes place immediately after stroke onset or vascular occlusion. Recruitment of collaterals and growth of preexisting collateral arterioles takes place almost immediately. This is not a process we have to wait for. Our imaging is actually showing this， both who does and who does not have collaterals as well as the attempted growth or arteriogenesis and collateralization process itself.
Dr. Liebeskind: 血管生成，更具体的说是动脉生成，在中风发生或血管闭塞后会立即发生。启用侧枝循环和已经存在的侧枝动脉的生长几乎是立即发生的。但这不是一个我们能等待的过程。我们的影像学实际上正显示了这一过程，不论是否有侧枝循环，或者正在长出侧枝循环或动脉生成以及侧枝化都会促进血管自身侧枝化。
[1] 2 [上一页]