[急性卒中早期CT评分-弥散加权成像、动脉闭塞部位及急性缺血性卒中亚型与静脉注射重组组织型纤溶酶原激活剂治疗后的预后相关]
[ASPECTS-DWI, arterial occlusion sites and subtype of acute ischemic stroke have a relation with outcome following intravenous rt-PA therapy].
作者信息
Idei Masaru, Sasaki Tatsuya, Tanabe Tomoyuki, Muraoka Kenichirou, Terada Kinya, Meguro Toshinari, Hirotsune Nobuyuki, Nishino Shigeki
机构信息
Department of Neurosurgery, Hiroshima City Hospital, Japan.
出版信息
No Shinkei Geka. 2012 Jul;40(7):585-91.
PURPOSE
We evaluated the usefulness of rating diffusion weighted images (DWI) using semiquantitative scores modified from the Alberta Stroke Programme Early CT Score (ASPECTS) to predict deterioration of neurological symptoms in patients with hyperacute ischemic stroke who had undergone thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA).
SUBJECTS AND METHODS
We examined 84 patients with acute ischemic stroke treated with intravenous rt-PA. Ischemic changes and vascular lesions were identified using DWI, and magnetic resonance angiography. Early ischemic signs were assessed using ASPECTS-DWI (11 points). Independent outcome was defined by NIHSS at 24 hours after intravenous rt-PA therapy.
RESULTS
A total of 58 patients were studied, and NIHSS 27 (46.6%) of them had improved by 4 points in 24 hours.
CONCLUSION
Cases of 0≦AD≦3, cardioembolic type cases with internal carotid artery occlusion in the group of 4≦AD≦7 and branch atheromatous disease in the group of 8≦AD were poor outcome at NIHSS 24 hours after intravenous rt-PA therapy for acute ischemic stroke patients.
目的
我们评估了使用从阿尔伯塔卒中项目早期CT评分（ASPECTS）修改而来的半定量评分对弥散加权成像（DWI）进行评级，以预测接受重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗的超急性缺血性卒中患者神经症状恶化情况的有效性。
受试者与方法
我们检查了84例接受静脉rt-PA治疗的急性缺血性卒中患者。使用DWI和磁共振血管造影识别缺血性改变和血管病变。使用ASPECTS-DWI（11分）评估早期缺血征象。独立结局由静脉rt-PA治疗后24小时的美国国立卫生研究院卒中量表（NIHSS）定义。
结果
共研究了58例患者，其中27例（46.6%）在24小时内NIHSS评分改善了4分。
结论
对于急性缺血性卒中患者，在静脉rt-PA治疗后24小时，ASPECTS-DWI评分为0≦AD≦3的病例、4≦AD≦7组中的心源性栓塞型伴颈内动脉闭塞病例以及8≦AD组中的分支动脉粥样硬化病病例，NIHSS结局较差。
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