临床/灌注CT脑血容量不匹配作为急性前循环卒中动脉内血栓切除术预后因素的研究
Clinical/perfusion CT CBV mismatch as prognostic factor in intraarterial thrombectomy in acute anterior circulation stroke.
作者信息
Saake Marc, Breuer Lorenz, Gölitz Philipp, Köhrmann Martin, Schwab Stefan, Dörfler Arnd, Kloska Stephan
机构信息
Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
出版信息
Clin Neurol Neurosurg. 2014 Jun;121:39-45. doi: 10.1016/j.clineuro.2014.03.007. Epub 2014 Mar 15.
OBJECTIVE
Contradictory results were reported for the outcome after endovascular recanalization (ERT) in acute anterior circulation ischemic stroke. We assessed whether a clinical/perfusion CT cerebral blood volume (CBV) mismatch concept (CPM) can identify patients who will benefit from reperfusion therapy.
METHODS
Imaging and clinical data of 58 consecutive ERT cases with acute anterior circulation stroke (ICA, M1, proximal M2) undergoing intraarterial thrombectomy within 4.5h after symptom onset were analyzed retrospectively. CPM was defined as NIHSS≥8 and PCT CBV ASPECTS≥7. Minor CBV lesion was defined as PCT CBV ASPECTS≥7.
RESULTS
All baseline characteristics other than blood glucose did not differ between the paired groups. Revascularization was achieved in 87.9% of all patients without significant difference between the paired groups. Favorable clinical outcome after 3 months (mRS≤2) resulted in 29.3% of all patients, in contrast to 47.4% of the CPM positive and 52.2% of the minor CBV lesion groups.
CONCLUSION
CPM can identify patients who will benefit from reperfusion therapy in acute anterior circulation ischemic stroke.
目的
关于急性前循环缺血性卒中血管内再通（ERT）后的结果，有相互矛盾的报道。我们评估了临床/灌注CT脑血容量（CBV）不匹配概念（CPM）能否识别出将从再灌注治疗中获益的患者。
方法
回顾性分析了58例症状发作后4.5小时内接受动脉内血栓切除术的急性前循环卒中（颈内动脉、M1、M2近端）连续ERT病例的影像学和临床资料。CPM定义为美国国立卫生研究院卒中量表（NIHSS）≥8且灌注CT（PCT）CBV脑缺血半暗带评分（ASPECTS）≥7。轻微CBV病变定义为PCT CBV ASPECTS≥7。
结果
除血糖外，所有配对组之间的所有基线特征均无差异。所有患者中有87.9%实现了血管再通，配对组之间无显著差异。3个月后良好的临床结局（改良Rankin量表评分[mRS]≤2）在所有患者中占29.3%，相比之下，CPM阳性组为47.4%，轻微CBV病变组为52.2%。
结论
CPM可识别急性前循环缺血性卒中中将从再灌注治疗中获益的患者。
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