《国际循环》：我们了解到，StrokeNet是一个在线卒中支持社区。作为StrokeNet网络主要负责人，您能否简要介绍这一项目?

　　International Circulation: We learned that StrokeNet is an on-line stroke support community. As PI for this program， could you please introduce this program briefly?

　　Broderick教授：StrokeNet是由政府和美国国立卫生研究院（NIH）资助的全国性的医院和研究人员网络。其创立初衷在于集中组织所有由政府资助的有关卒中急性期治疗、预防及康复试验，是一个研究网络。过去10年，其规模较小，目前得到发展壮大，涉及全国25个区域中心约250家医院。另外一个项目为卒中护理系统，包括初级卒中中心及综合性卒中中心，这是一个患者倡导的组织，每家医院均得到了美国心脏协会、美国卒中协会及联合委员会的认证，能通过tPA的使用、大脑成像及患者护理，提供良好的日常卒中治疗系统。医院授权的卒中中心可开展更多血管内治疗或外科治疗脑出血。这样就形成了患者首先到初级卒中中心就诊，而后到综合性卒中中心行更先进治疗的卒中治疗体系。总体来说，我们有两个系统，一是基于疾病治疗，另一是基于研究，而一家医院可兼具以上两种。

　　Dr Broderick: StrokeNet is a network of hospitals and researchers throughout the country that is funded by our government， by the National Institute of Health. The idea here is to centralize and organize all of the stroke trials that are funded by the government; for acute treatment， for prevention and also for recovery. It’s a network for research and previously we had a smaller version of it over the last 10 years this is the larger version， so we have 25 regional centers in the country， so far about 250 hospitals where the research will be taking place. This is a place for research， another way in a country that stroke care is being organized is what’s called Stroke System of Care; which includes primary stroke centers and comprehensive stroke centers. This is one of our patient advocacy organizations， American Heart， American Stroke Association working with a group called Joint Commission certifies hospitals that says “This hospital is organized in the way that they can provide daily good system stroke care through the use of tPA being able to take pictures of the brain and care for patients.” There is a next level of care which is called Copyrights of Stroke Centers; this would be a center that could do more interventional therapy such as endovascular removal of flap or more surgical approaches for bleeding in the brain. So then we have a system of care where patients are first brought in to a primary stroke center but then can go to a comprehensive stroke center needed for more advanced care. So we have 2 systems: One is based on delivery of care and the other is based on research. A hospital can be both part of the research network as well as assistance of care.

　　《国际循环》：保证StrokeNet项目正常运转的因素是什么？

　　International Circulation: Thank you. You have just introduced about the strokeNet， so what’s the factors to ensure its normal progress?

　　Broderick教授：我们应如何确保StrokeNet项目正常运转？全国参与及未参与StrokeNet项目的研究者会提出一些想法即所谓的“试验”，然后StrokeNet及NIH的专家会对临床试验理念进行评估和审批。一旦审查获批，政府会拨款开展这些试验，一般会长达数年。若试验能在卒中患者治疗方面取得进展，我们会尝试将其整合至卒中护理系统中。

　　Dr Broderick: How do we make sure that we are making progress with the StrokeNet; our group of investigators and researchers throughout the country who are or are not part of StrokeNet they come up with ideas which we call that trials. Then we have a process which by clinical trial ideas are evaluated and approved by both the StrokeNet people as well as the National Institute of Health. Once it gets ready to be submitted， it gets reviewed and then after it gets reviewed the decision made by the government to give money and then with the money we do the trial which would take several years. Hopefully when we have the results of trials that made a difference we make progress in how we care for stroke patients and then we try to make that go into the system care.

　　《国际循环》：StrokeNet迄今在社区卒中管理中发挥了怎样的作用？

　　International Circulation: What does the role it plays in stroke management of the community?

　　Broderick教授：StrokeNet并不一定参与对社区患者治疗的管理，而是参与卒中研究。但是，参加研究的医院及研究者会参与社区患者的管理。

　　Dr Broderick: StrokeNet is not necessarily involved in managing the care of patients in the community. It’s strictly involved with research， but the same kind of hospitals that do the research and the leaders there are also involved in the care of patients in the community.

　　《国际循环》：发展中国家如中国的卒中负担十分严峻，根据您开展StrokeNet的经验，对于类似于中国的卒中管理，您有哪些好的建议呢？

　　International Circulation: Developing coutries like China now bear heavy burdens of stroke， according to your experience of leading StrokeNet， do you have some suggestions on community management of stroke?

　　Broderick教授：我认为，当卒中负担非常严峻时，要尽一切努力预防卒中，这是降低卒中负担、改变现状的最快方法。我认为中国在卒中危险因素管理中，应首先控制血压。其次，对可影响血压及糖尿病的饮食进行调整。尤其应强调的是需马上戒烟。血压控制通常需较长时间且花费较大，而戒烟不但可避免这一危险因素，还能节省花费，将钱用在其他地方。

　　Dr Broderick: Well， I think the first thing is when there is a heavy burden， ideally， you would like to do everything to prevent a stroke; that’s the way you make the most difference， most quickly. So I think managing the risk factors in China is to control the blood pressure firstly. Secondly， is the diet which affects blood pressure and diabetes， and most importantly that you can do right now is to stop smoking; that’s something you can take right away. Whereas blood pressure you would have to do over a longer period of time and you need money to do that; by stopping smoking you get rid of a risk factor which also saves money because you got money to spend on something else.

　　《国际循环》：自1995年NINDS rt-PA静脉溶栓试验发表以来，急性缺血性卒中治疗进入再灌注治疗时代。目前，临床中常用的再灌注策略是什么？

　　International Circulation: Since the publication of NINDS rt-PA stroke study in 1995， treatment of acute ischemic stroke has entered into an era of reperfusion therapy. What reperfusion strategies are commonly used in clinical practice?

　　Broderick教授：我也曾参与了最初的研究，tPA和卒中效力较强的研究可追溯到20世纪80年代晚期至90年代初期。tPA首先在美国获批，后在其他国家应用，是急性缺血性卒中的第一种治疗药物。我们知道，它非常有效，且作用具有时间依赖性，可在发病1~1.5小时内应用，3~4小时内使用预后更好，但超过4.5小时后作用微乎其微且可能导致更多并发症。20多年后的今天，我们有了除tPA外的更多先进治疗方法。例如，对tPA溶栓效果不佳的患者，可应用相关设备进入动脉除栓，对合适患者来说获益极大，但这需有掌握这种技术达一定水平的专业人员，行脑部影像学检查确定动脉血栓阻塞后，经培训的术者才可应用该技术去除血栓。这种技术在任何国家都是一项巨大投资，但确实能显著改善适宜患者的预后。

　　Dr Broderick: I was part of the original trial， the power trial which had tPA and stroke back in the late 1980’s， believe it or not， into the early 90’s. When that was approved first in the United States then in other countries it was the first treatment for acute ischemic stroke. We know it works as effective therapy and its very time dependent， so you can get it within an hour or hour and half after onset; you can have a much better outcome than if you get it three to four hours after onset and beyond four and a half hours it doesn’t help patients in fact it can lead to more complications. Now 20 years later， we have now the next advance beyond tPA which is using devices which can go inside the artery to remove the blood clots and used on patients in which tPA has not been effective in removing the clot.  It can make a big difference for the right patients， but it takes certain level of expertise to use the technology because you have to be able to get a picture of the brain， and you have to know that you have a blood clot blocking one of the arteries. Then you have to have the technology to move it as well as people that are very well trained in using the technology. It’s a big investment for any country， but for the right patient it could make a big difference.

　　《国际循环》：人们都说我们需像心脏病专家治疗心肌梗死那样来治疗卒中。您对此作何评论？

　　International Circulation: People are saying that we should treat stroke as cardiologists treat myocardial infarction. What is your comment on that?

　　Broderick教授：我认为心肌梗死与卒中治疗存在很多相似之处。我哥哥是位介入心脏病学家，他说我们比他们落后了，但我认为我们已经赶上了他们。但是，心肌梗死与卒中有所不同。大多数情况下，心肌梗死时的栓塞是因动脉斑块及血栓形成所致；而卒中时多由其他部位栓子脱落、堵塞脑动脉所致。因此，二者所应用的血栓去除技术存在差异。

　　Dr Broderick: I think there are a lot of similarities. My brother is actually an interventional cardiologist， so he would say we have been behind the cardiologist; well I say we’ve caught up with them and we are going to catch them， but one thing that’s different in the heart is that most of the time the clot is actually due to a plaque in the artery itself with thrombosis. In the brain， most of the time it’s due to the embolus， a clot that breaks off from another place and plugs the artery in the brain; so the technology to remove the clot is different than that used in myocardial infarction.