Department of Neuroradiology, University Clinics of Schleswig-Holstein, Arnold-Heller-Str.3, 24105 Kiel, Germany.
Stroke. 2011 Jun;42(6):1775-7. doi: 10.1161/STROKEAHA.110.609693. Epub 2011 Apr 7.
We hypothesize that in acute middle cerebral artery stroke, thrombus lengths measured in thin-slice nonenhanced CT images define a limit beyond which systemic thrombolysis will fail to recanalize occluded arteries.
In 138 patients who presented with acute middle cerebral artery stroke and who were treated with intravenous thrombolysis (IVT), we measured lengths of thrombotic clots depicted as arterial hyperdensities in admission nonenhanced CT images with 2.5-mm slice width. Vascular recanalization was investigated after thrombolysis and recanalization results were related to thrombus lengths by logistic regression.
In 62 patients, IVT resulted in recanalization; among these patients, no thrombus length exceeded 8 mm. The median modified Rankin scale score at hospital discharge was 2. In the remaining 76 patients, thrombus lengths mostly exceeded 8 mm and IVT failed in recanalization. These patients were discharged with a median modified Rankin scale score of 5.
This study shows that in acute middle cerebral artery stroke, IVT has nearly no potential to recanalize occluded vessels if thrombus length exceeds 8 mm.
我们假设，在急性大脑中动脉卒中中，薄层非增强 CT 图像上测量的血栓长度界定了一个界限，如果超过这个界限，系统溶栓将无法使闭塞的动脉再通。
在 138 名接受静脉溶栓（IVT）治疗的急性大脑中动脉卒中患者中，我们测量了入院时非增强 CT 图像上以 2.5mm 层厚显示的动脉高密度血栓的长度。在溶栓后研究了血管再通情况，并通过逻辑回归将再通结果与血栓长度相关联。
在 62 名患者中，IVT 导致了再通；在这些患者中，没有血栓长度超过 8mm。出院时中位数改良 Rankin 量表评分为 2。在其余 76 名患者中，血栓长度大多超过 8mm，IVT 未能再通。这些患者出院时的中位数改良 Rankin 量表评分为 5。
这项研究表明，在急性大脑中动脉卒中中，如果血栓长度超过 8mm，IVT 几乎没有使闭塞血管再通的潜力。
