Jovin T G, Gupta R, Horowitz M B, Grahovac S Z, Jungreis C A, Wechsler L, Gebel J M, Yonas H
Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
AJNR Am J Neuroradiol. 2007 Jan;28(1):164-7.
The aim of acute stroke interventions is to achieve recanalization of the target occluded artery. We sought to determine whether pretreatment cortical cerebral blood flow (CBF) was associated with vessel recanalization in patients undergoing intra-arterial therapy.
This is a retrospective analysis of patients who underwent a quantitative xenon CT blood flow study and were noted to have a documented M1 middle cerebral artery (MCA) or carotid terminus occlusion less than 6 hours from symptom onset between January 1997 and April 2001. Twenty-three patients who underwent intra-arterial thrombolysis were included in the analysis. Univariate and multivariate analyses were performed to determine whether pretherapy CBF was correlated to the likelihood of recanalization.
A total of 23 patients were studied in this analysis with a median age of 69 (range 32-81) and median National Institutes of Health Stroke Score of 19 (range, 8-22). Twelve patients (52%) underwent combined intravenous/intra-arterial therapy, and 11 patients (48%) were treated with intra-arterial thrombolytics alone. Successful vessel recanalization (Thrombolysis in Myocardial Infarction classification 2 or 3 flow) occurred in 13 patients (57%). The only variable associated with recanalization in multivariate modeling was mean ipsilateral MCA CBF (odds ratio, 1.25; 95% confidence interval, 1.01-1.54; P = .035). A receiver operating characteristic curve was generated, and a mean ipsilateral MCA CBF threshold of 18 mL/100 g/min was found to be the threshold for successful recanalization.
Our study suggests that patients with higher mean ipsilateral MCA CBF are more likely to recanalize. The threshold for successful revascularization may be 18 mL/100 g/min. Further study is required to determine whether pretreatment CBF is related to recanalization success.
急性中风干预的目标是实现目标闭塞动脉的再通。我们试图确定动脉内治疗患者的治疗前皮质脑血流量（CBF）是否与血管再通相关。
这是一项对接受定量氙CT血流研究的患者的回顾性分析，这些患者在1997年1月至2001年4月期间被记录为症状发作后不到6小时出现大脑中动脉M1段（MCA）或颈动脉末端闭塞。分析纳入了23例行动脉内溶栓治疗的患者。进行单因素和多因素分析以确定治疗前CBF是否与再通可能性相关。
本分析共研究了23例患者，中位年龄为69岁（范围32 - 81岁），美国国立卫生研究院卒中量表中位评分为19分（范围8 - 22分）。12例患者（52%）接受了静脉/动脉联合治疗，11例患者（48%）仅接受动脉内溶栓治疗。13例患者（57%）实现了成功的血管再通（心肌梗死溶栓分类2级或3级血流）。多因素建模中与再通相关的唯一变量是同侧MCA平均CBF（优势比，1.25；95%置信区间，1.01 - 1.54；P = 0.035）。生成了一条受试者工作特征曲线，发现同侧MCA平均CBF阈值为18 mL/100 g/min是成功再通的阈值。
我们的研究表明，同侧MCA平均CBF较高的患者更有可能实现再通。成功血管再通的阈值可能为18 mL/100 g/min。需要进一步研究以确定治疗前CBF是否与再通成功相关。
