İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW

Yemisci, Muge; Gurler, Gokce; Soylu, Kadir Oguzhan

doi:10.5505/tbdhd.2021.83435

İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW

Gökçe GÜRLER, (Hacettepe Üniversitesi, Nörolojik Bilimler ve Psikiyatri Enstitüsü, Ankara, Türkiye)

Kadir Oğuzhan SOYLU, (Hacettepe Üniversitesi, Nörolojik Bilimler ve Psikiyatri Enstitüsü, Ankara, Türkiye)

Müge YEMİŞCİ ÖZKAN (Hacettepe Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Ankara, Türkiye)

Türk Beyin Damar Hastalıkları Dergisi

4 2

Yıl: 2021 Cilt: 27 Sayı: 3 Sayfa Aralığı: 179 - 190 Metin Dili: Türkçe DOI: 10.5505/tbdhd.2021.83435 İndeks Tarihi: 12-07-2022

İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW

Öz:

İskemik inme sonrası tıkanan büyük damarın geri açılmasına dayanan rekanalizasyon tedavileri günümüzdeki tek tedavi seçeneğidir ve klinik fonksiyonu iyileştirmede önemli ilerlemeler sağlamıştır. Ancak rekanalizasyon sağlanması her zaman doku sağ kalımı ve olumlu fonksiyonel iyileşme ile sonlanmamaktadır. Bu uyumsuzluğun altında yatan çeşitli nedenlerden bir tanesi “no-reflow” fenomenidir. Bu terim ilk olarak kardiyoloji literatüründe rekanalizasyon sağlanmasına rağmen parankimal dokuda reperfüzyon sağlanamaması durumunu tarif etmek için kullanılmıştır. Takip eden dönemde deneysel iskemik inme modellerinde, tıkalı büyük damarların açılmasına karşın kan akımının mikrodolaşım düzeyinde düzelmemesi ile seyreden benzer bir sürecin varlığı kanıtlanmıştır. Uzun yıllardır deneysel çalışmalarda varlığı bilinen ancak patofizyolojisi tam olarak aydınlatılamayan bu fenomenin nedenlerinden bazıları kan elemanlarının aggregasyonu, kan vizkositesinde artma, nörovasküler ünite hücrelerinden perisitlerin kasılarak mikrodamarları daraltması, inflamatuar süreçlerin aktifleşmesidir. Bu fenomen, rekanalizasyon tedavilerinin başarısının istenen düzeyde olamamasına neden olduğundan özellikle klinik çalışmalarla patofizyolojisinin tam olarak aydınlatılması gereklidir. İskemik inmede rekanalizayon tedavisi yanında reperfüzyonu iyileştirmeye yönelik kokteyl tedavileri “no-reflow’’ fenomenini önleyebilir.

Anahtar Kelime:

THE MYSTERIOUS PHENOMENON OF ISCHEMIC STROKE: NO-REFLOW

Öz:

Recanalization therapies based on reopening of the occluded great vessel after ischemic stroke are the only treatment options available today and have made significant advances in improving clinical function. However, providing recanalization does not always result in tissue survival and positive functional recovery. One of the various reasons underlying this incompatibility is the "no-reflow" phenomenon. This term was first used in the cardiology literature to describe the situation in which parenchymal tissue reperfusion was not achieved despite recanalization. In the following period, the existence of a similar process in experimental ischemic stroke models, in which the blood flow did not improve at the microcirculation level despite the opening of the occluded great vessels, was proven. Some of the causes of this phenomenon, which has been known in experimental studies for many years but whose pathophysiology has not been fully elucidated, are the aggregation of blood elements, increase in blood viscosity, contraction of pericytes -a component of neurovascular unit, narrowing of microvessels, and activation of inflammatory processes. Since this phenomenon causes the success of recanalization treatments not to be at the desired level, its pathophysiology should be fully elucidated, especially through clinical studies. Cocktail therapies to improve reperfusion besides recanalization therapy in ischemic stroke can prevent the "no-reflow" phenomenon.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	Gurler G, Soylu K, Yemisci M (2021). İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. , 179 - 190. 10.5505/tbdhd.2021.83435
Chicago	Gurler Gokce,Soylu Kadir Oguzhan,Yemisci Muge İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. (2021): 179 - 190. 10.5505/tbdhd.2021.83435
MLA	Gurler Gokce,Soylu Kadir Oguzhan,Yemisci Muge İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. , 2021, ss.179 - 190. 10.5505/tbdhd.2021.83435
AMA	Gurler G,Soylu K,Yemisci M İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. . 2021; 179 - 190. 10.5505/tbdhd.2021.83435
Vancouver	Gurler G,Soylu K,Yemisci M İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. . 2021; 179 - 190. 10.5505/tbdhd.2021.83435
IEEE	Gurler G,Soylu K,Yemisci M "İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW." , ss.179 - 190, 2021. 10.5505/tbdhd.2021.83435
ISNAD	Gurler, Gokce vd. "İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW". (2021), 179-190. https://doi.org/10.5505/tbdhd.2021.83435

APA	Gurler G, Soylu K, Yemisci M (2021). İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. Türk Beyin Damar Hastalıkları Dergisi, 27(3), 179 - 190. 10.5505/tbdhd.2021.83435
Chicago	Gurler Gokce,Soylu Kadir Oguzhan,Yemisci Muge İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. Türk Beyin Damar Hastalıkları Dergisi 27, no.3 (2021): 179 - 190. 10.5505/tbdhd.2021.83435
MLA	Gurler Gokce,Soylu Kadir Oguzhan,Yemisci Muge İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. Türk Beyin Damar Hastalıkları Dergisi, vol.27, no.3, 2021, ss.179 - 190. 10.5505/tbdhd.2021.83435
AMA	Gurler G,Soylu K,Yemisci M İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. Türk Beyin Damar Hastalıkları Dergisi. 2021; 27(3): 179 - 190. 10.5505/tbdhd.2021.83435
Vancouver	Gurler G,Soylu K,Yemisci M İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW. Türk Beyin Damar Hastalıkları Dergisi. 2021; 27(3): 179 - 190. 10.5505/tbdhd.2021.83435
IEEE	Gurler G,Soylu K,Yemisci M "İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW." Türk Beyin Damar Hastalıkları Dergisi, 27, ss.179 - 190, 2021. 10.5505/tbdhd.2021.83435
ISNAD	Gurler, Gokce vd. "İSKEMİK İNMENİN GİZEMLİ FENOMENİ: NO-REFLOW". Türk Beyin Damar Hastalıkları Dergisi 27/3 (2021), 179-190. https://doi.org/10.5505/tbdhd.2021.83435