Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
J Stroke Cerebrovasc Dis. 2011 Jan-Feb;20(1):62-67. doi: 10.1016/j.jstrokecerebrovasdis.2009.11.002. Epub 2010 Jun 17.
In recent years, patient selection for intravenous tissue plasminogen activator (t-PA) therapy based on clinical-diffusion mismatch (CDM) has been closely examined. We investigated the relationship between prognosis and CDM in patients with hyperacute cerebral infarction within 3 hours of onset and compared CDM with diffusion-perfusion mismatch (DPM). Of 122 patients with hyperacute cerebral infarction who visited the hospital within 3 hours of onset between April 2007 and November 2008, 85 patients with cerebral infarction in the anterior circulation who underwent head magnetic resonance imaging diffusion-weighted imaging (DWI)/magnetic resonance angiography (MRA) (51 men and 34 women; average age, 74 ± 10 years) were enrolled. Seventeen of these patients underwent CT perfusion imaging. CDM-positive cases were those with a National Institute of Health Stroke Scale (NIHSS) score ≥ 8 and a DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≥ 8; CDM-negative cases were those with an NIHSS score ≥ 8 and an ASPECTS-DWI < 8. The other patients were classified as belonging to the NIHSS score < 8 group. Of the 32 CDM-positive cases, 10 received t-PA infusion. These patients had markedly higher modified Rankin Scale scores 90 days after onset compared with the 22 patients who did not receive t-PA infusion. The 8 CDM-positive cases included 4 DPM-positive cases and 4 DPM-negative cases, and a discrepancy was confirmed between CDM and DPM. In all DPM-positive cases, MRA confirmed lesions in major intracranial arteries. CDM may enable more accurate prediction of outcomes in patients with hyperacute cerebral infarction. In addition, the combination of CDM findings and MRA findings (stenosis or occlusion in major intracranial arteries) may be an alternative to DPM for determining the indications for IV t-PA therapy in patients with hyperacute cerebral infarction.
近年来，基于临床-弥散不匹配（CDM）的患者选择静脉组织型纤溶酶原激活剂（t-PA）治疗已受到密切关注。我们研究了发病 3 小时内的超急性脑梗死患者的预后与 CDM 的关系，并将 CDM 与弥散-灌注不匹配（DPM）进行了比较。2007 年 4 月至 2008 年 11 月期间，发病 3 小时内就诊的 122 例超急性脑梗死患者中，85 例前循环脑梗死患者接受了头部磁共振成像弥散加权成像（DWI）/磁共振血管造影（MRA）检查（51 名男性，34 名女性；平均年龄 74±10 岁），其中 17 例患者进行了 CT 灌注成像。CDM 阳性病例定义为 NIHSS 评分≥8 分且 DWI-Alberta 卒中计划早期 CT 评分（DWI-ASPECTS）≥8 分；CDM 阴性病例定义为 NIHSS 评分≥8 分且 ASPECTS-DWI＜8 分。其余患者被归类为 NIHSS 评分＜8 分的患者。在 32 例 CDM 阳性病例中，10 例接受了 t-PA 输注。与未接受 t-PA 输注的 22 例患者相比，这些患者在发病后 90 天的改良 Rankin 量表评分明显更高。8 例 CDM 阳性病例中，4 例为 DPM 阳性病例，4 例为 DPM 阴性病例，CDM 与 DPM 之间存在差异。所有 DPM 阳性病例的 MRA 均证实存在颅内大血管病变。CDM 可能更准确地预测超急性脑梗死患者的预后。此外，CDM 结果与 MRA 结果（颅内大血管狭窄或闭塞）的结合可能是 DPM 的替代方法，用于确定超急性脑梗死患者 IV t-PA 治疗的适应证。
