Christoforidis G A, Mohammad Y, Avutu B, Tejada A, Slivka A P
Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, USA.
AJNR Am J Neuroradiol. 2006 Aug;27(7):1528-31.
This study sought to determine whether the angiographic demonstration of slow antegrade contrast opacification of an occluded cerebral artery distal to the thrombus (clot outline sign) on cerebral arteriograms performed immediately before thrombolytic treatment is associated with higher recanalization rates relative to patients without antegrade contrast opacification distal to the occlusion site.
The angiographic images of 100 consecutive arteriograms performed before thrombolysis in patients eligible for intra-arterial thrombolysis from May 1995 to February 2005 were reviewed. A modified Thrombolysis in Myocardial Infarction flow grade (mTIMI) was adapted to grade recanalization after cerebral thrombolysis. Clot outline sign was defined as slow antegrade contrast opacification distal to the thrombus on the delayed images of the presenting arteriogram. Logistic regression analysis for mTIMI grade included the following potential predictors: presence of outline sign, age, time to treatment, sex, site of occlusion, presenting National Institutes of Health Stroke Scale (NIHSS) score, presenting platelets, presenting systolic blood pressure, presence of pial collaterals, and admitting glucose value.
Eighty-seven arteriograms were reviewed. Of these, 19 (22%) displayed the clot outline sign. Thirteen (69%) of 19 had clot outline sign, and 16 of 68 (29%) were not completely recanalized (mTIMI = 3); 95% with clot outline sign and 54% without were associated with either mTIMI 2 or 3 (P = .0055, Pearson correlation). Logistic regression analysis for recanalization relative to other predictors indicates that only the clot outline sign could act as a statistically significant predictor for recanalization (P = .0007).
Prethrombolysis cerebral arteriograms demonstrating delayed antegrade contrast opacification distal to the occlusion site are associated with higher recanalization rates.
本研究旨在确定在溶栓治疗前即刻进行的脑动脉造影中，血栓远端闭塞脑动脉的造影剂缓慢顺行性充盈显影（血栓轮廓征）与未出现闭塞部位远端造影剂顺行性充盈显影的患者相比，再通率是否更高。
回顾了1995年5月至2005年2月期间符合动脉内溶栓条件的患者在溶栓前进行的100例连续动脉造影图像。采用改良的心肌梗死溶栓血流分级（mTIMI）对脑溶栓后的再通情况进行分级。血栓轮廓征定义为在首次动脉造影延迟图像上血栓远端造影剂缓慢顺行性充盈显影。对mTIMI分级进行逻辑回归分析，纳入以下潜在预测因素：轮廓征的存在、年龄、治疗时间、性别、闭塞部位、首次美国国立卫生研究院卒中量表（NIHSS）评分、首次血小板计数、首次收缩压、软脑膜侧支循环的存在以及入院时血糖值。
共回顾了87例动脉造影图像。其中，19例（22%）显示有血栓轮廓征。19例中有13例（69%）有血栓轮廓征，68例中16例（29%）未完全再通（mTIMI = 3）；有血栓轮廓征的患者中95%以及无血栓轮廓征的患者中54%与mTIMI 2或3相关（P = 0.0055，Pearson相关性）。相对于其他预测因素对再通进行逻辑回归分析表明，只有血栓轮廓征可作为再通的统计学显著预测因素（P = 0.0007）。
溶栓前脑动脉造影显示闭塞部位远端造影剂延迟顺行性充盈显影与更高的再通率相关。
