Interpretation of 2019 Stroke and Transient Ischaemic Attack in over 16s：Diagnosis and Initial Management from the National Institute for Health and Care Excellence（1）

doi:10.12114/j.issn.1007-9572.2020.00.264

Abstract

Abstract: The National Institute for Health and Care Excellence（NICE） published its guidelines on stroke and transient ischaemic attack（TIA） as early as July 2008，but the management of stroke is changing now.New evidence has emerged in areas such as thrombectomy in ischaemic stroke.In addition，there are some uncertainties about the use of Aspirin for the first suspected diagnosis of TIA，the role of traditional risk stratification in TIA，and the best practice to intracerebral imaging after TIA.Therefore，in May 2019，NICE released the latest guidelines Stroke and Transient Ischaemic Attack in over 16s：Diagnosis and Initial Management to update recommendations on these specific issues，and it offered the best clinical recommendations for the diagnosis and treatment of acute stroke and TIA in 48 hours after onset of symptoms.There are nine recommendations in the NICE guidelines and this article interprets the recommendations in "1.1.1~1.4.8" based on the relevant research progress，including rapid recognition of symptoms and diagnosis，imaging for people who have had a suspected TIA or acute non-disabling stroke，specialist care for people with acute stroke，and pharmacological treatments and thrombectomy for people with acute stroke.The interpretation of this guideline can provide reference for the practical work of clinicians in Emergency Department，Department of Neurology and other departments in China，and optimize the clinical efficacy.

Key words: Stroke；Ischemic attack, transient；Guidelines；Interpretation

摘要： 英国国家卫生与临床优化研究所（NICE）于2008年7月发布了《急性卒中和短暂性脑缺血发作的诊断和最初管理指南》，但卒中的治疗发生了变化，在缺血性卒中血栓清除术方面出现了新的证据，且首次怀疑TIA时阿司匹林的使用、传统的危险分层在短暂性脑缺血发作（TIA）中的作用及TIA影像学成像的最佳策略等尚存在一些不确定性。所以NICE 2019年5月又公布了新版《大于16岁人群卒中和TIA的诊断和初期管理指南》，以补充阐释上述问题，为TIA（疑诊或确诊）和脑卒中急性发作后48 h的诊断和治疗提供最佳临床建议。NICE指南共有9条推荐意见，本文结合相关研究进展对其中的“1.1.1~1.4.8条”推荐意见进行解读，内容包括快速识别和诊断、疑诊TIA或急性非致残性卒中的影像学检查、急性卒中的专科处理、急性卒中溶栓和血栓清除术。通过对该指南的解读，可以为我国急诊科、神经科等临床医师的实践工作提供参考，优化临床疗效。

关键词: 卒中；脑缺血发作, 短暂性；指南；解读

LI Zhenghuan,SONG Xueli,LIU Xin, et al. Interpretation of 2019 Stroke and Transient Ischaemic Attack in over 16s：Diagnosis and Initial Management from the National Institute for Health and Care Excellence（1）　[J]. Chinese General Practice, 2020, 23(16): 1972-1976. DOI: 10.12114/j.issn.1007-9572.2020.00.264.
李正欢,宋雪利,刘昕等. 2019 年NICE《大于16岁人群卒中和短暂性脑缺血发作的诊断和初期管理指南》解读（一）[J]. 中国全科医学, 2020, 23(16): 1972-1976. DOI: 10.12114/j.issn.1007-9572.2020.00.264.

References

［1］NICE．Stroke and transient ischaemic attack in over 16s：diagnosis and initial management［Z］．2019.
［2］ZHAO J，LIU R．Stroke 1-2-0：a rapid response programme for stroke in China［J］．Lancet Neurol，2017，16（1）：27-28．DOI：10.1016/S1474-4422(16)30283-6.
［3］ZERNA C，THOMALLA G，CAMPBELL B C V，et al．Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke［J］．Lancet，2018，392（10154）：1247-1256．DOI：10.1016/s0140-6736(18)31874-9.
［4］CULIC V．Ticagrelor versus Aspirin in acute stroke or transient ischemic attack［J］．N Engl J Med，2016，375（14）：1394-1395．DOI：10.1056/nejmoa1603060.
［5］AMARENCO P，LAVALLEE P C，MONTEIRO-TAVARES L，et al．Five-year risk of stroke after TIA or minor ischemic stroke［J］．N Engl J Med，2018，378（23）：2182-2190．DOI：10.1056/nejmoa1802712.
［6］JOHNSTON S C，EASTON J D，FARRANT M，et al．Clopidogrel and Aspirin in acute ischemic stroke and high-risk TIA［J］．N Engl J Med，2018，379（3）：215-225．DOI：10.1056/nejmoa1800410.
［7］GROTTA J C．Antiplatelet therapy after ischemic stroke or TIA［J］．N Engl J Med，2018，379（3）：291-292．DOI：10.1056/NEJMe1806043.
［8］DAVIS S M，DONNAN G A．Carotid-artery stenting in stroke prevention［J］．N Engl J Med，2010，363（1）：80-82．DOI：10.1056/NEJMe1005220.
［9］MITKA M．Reducing door-to-needle time for tPA use remains an elusive goal in stroke care［J］．JAMA，2011，305（13）：1288-1289．DOI：10.1001/jama.2011.378.
［10］XIAN Y，HOLLOWAY R G，CHAN P S，et al．Association between stroke center hospitalization for acute ischemic stroke and mortality［J］．JAMA，2011，305（4）：373-380．DOI：10.1001/jama.2011.22.
［11］NICE．Alteplase for treating acute ischaemic stroke［Z］．2012.
［12］BAIRD A E．Paving the way for improved treatment of acute stroke with tenecteplase［J］．N Engl J Med，2018，378（17）：1635-1636．DOI：10.1056/NEJMe1801978.
［13］CAMPBELL B C V，MITCHELL P J，CHURILOV L，et al．Tenecteplase versus Alteplase before thrombectomy for ischemic stroke［J］．N Engl J Med，2018，378（17）：1573-1582.
［14］SILA C．Finding the right t-PA dose for Asians with acute ischemic stroke［J］．N Engl J Med，2016，374（24）：2389-2390．DOI：10.1056/NEJMoa1716405.
［15］BRODERICK J P．The challenges of intracranial revascularization for stroke prevention［J］．N Engl J Med，2011，365（11）：1054-1055．DOI：10.1056/NEJMe1108394.
［16］WARDLAW J M，BATH P M．Stroke research in 2018：extended time windows，refined benefit，and lifestyle prevention targets［J］．Lancet Neurol，2019，18（1）：2-3．DOI：4422(18)30457-5.
［17］NOGUEIRA R G，JADHAV A P，HAUSSEN D C，et al．Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct［J］．N Engl J Med，2018，378：11-21．DOI：10.1056/NEJMoa1706442.
［18］THOMALLA G，SIMONSEN C Z，BOUTITIE F，et al．MRI-guided thrombolysis for stroke with unknown time of onset［J］．N Engl J Med，2018，379：611-622．DOI：10.1056/NEJMoa1804355.
［19］ZERNA C，THOMALLA G，CAMPBELL B C V，et al．Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke［J］．Lancet，2018，392（10154）：1247-1256．DOI：6736(18)31874-9.
［20］THOMALLA G，SIMONSEN C Z，BOUTITIE F，et al．MRI-guided thrombolysis for stroke with unknown time of onset［J］．N Engl J Med，2018，379（7）：611-622．DOI：10.1056/NEJMoa1804355.
［21］NOGUEIRA R G，JADHAV A P，HAUSSEN D C，et al．Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct［J］．N Engl J Med，2018，378（1）：11-21．DOI：10.1056/NEJMoa1706442.

[1]	LI Zhenghuan，CHEN Yang，SONG Xueli，LIU Xin，WANG Fei，LI Hong. Interpretation（No.2） of Stroke and Transient Ischaemic Attack in Over 16s：Diagnosis and Initial Management 　 [J]. Chinese General Practice, 2021, 24(7): 775-779.
[2]	REN Jing，WANG Yongle，LIU Tingting，NIU Xiaoyuan. Dual Antiplatelet Therapy for Mild Stroke or Transient Ischemic Attack：from Clinical Guidelines to Real-world Evidence　 [J]. Chinese General Practice, 2021, 24(21): 2696-2700.