From the Department of Neurology (V.R., L.C., P.S., J.P.) and Department of Imaging Methods (J.B., R.T., J.F.), Faculty of Medicine in Plzen, Charles University in Prague and Faculty Hospital Plzen, Plzen, Czech Republic; Department of Mathematics, Faculty of Applied Sciences, University of West Bohemia Plzen, Plzen, Czech Republic (M.F.); and Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic (J.P.).
Stroke. 2014 Jul;45(7):2010-7. doi: 10.1161/STROKEAHA.114.005731. Epub 2014 Jun 10.
The length of large vessel occlusion is considered a major factor for therapy in patients with ischemic stroke. We used 4D-CT angiography evaluation of middle cerebral artery occlusion in prediction of recanalization and favorable clinical outcome and after intravenous thrombolysis (IV-tPA).
In 80 patients treated with IV-tPA for acute complete middle cerebral artery/M1 occlusion determined using CT angiography and temporal maximum intensity projection, calculated from 4D-CT angiography, the length of middle cerebral artery proximal stump, occlusion in M1 or M1 and M2 segment were measured. Univariate and multivariate analyses were performed to define independent predictors of successful recanalization after 24 hours and favorable outcome after 3 months.
The length of occlusion was measureable in all patients using temporal maximum intensity projection. Recanalization thrombolysis in myocardial infarction 2 to 3 was achieved in 37 individuals (46%). The extension to M2 segment as a category (odds ratio, 4.58; 95% confidence interval, 1.39-15.05; P=0.012) and the length of M1 segment occlusion (odds ratio, 0.82; 95% confidence interval, 0.73-0.92; P=0.0007) with an optimal cutoff value of 12 mm (sensitivity 0.67; specificity 0.71) were significant independent predictors of recanalization. Favorable outcome (modified Rankin scale 0-2) was achieved in 25 patients (31%), baseline National Institutes of Health Stroke Scale (odds ratio, 0.82; 95% confidence interval, 0.72-0.93; P=0.003) and the length of occlusion M1 in segment (odds ratio, 0.79; 95% confidence interval, 0.69-0.91; P=0.0008) with an optimal cutoff value of 11 mm (sensitivity 0.74; specificity 0.76) were significant independent predictors of favorable outcome.
The length of middle cerebral artery occlusion is an independent predictor of successful IV-tPA treatment.
大血管闭塞的长度被认为是缺血性脑卒中患者治疗的一个主要因素。我们使用 4D-CT 血管造影评估大脑中动脉闭塞，以预测静脉溶栓（IV-tPA）后的再通和良好的临床结局。
在 80 例经 CT 血管造影和时间最大强度投影确定的急性完全大脑中动脉/M1 闭塞并接受 IV-tPA 治疗的患者中，从 4D-CT 血管造影中计算出大脑中动脉近端残端的长度、M1 段或 M1 和 M2 段的闭塞长度。进行单变量和多变量分析，以确定 24 小时后再通和 3 个月后良好结局的独立预测因素。
使用时间最大强度投影可在所有患者中测量闭塞长度。37 例（46%）患者达到溶栓治疗后血栓再通 2-3 级。M2 段闭塞的扩展作为一个类别（比值比，4.58；95%置信区间，1.39-15.05；P=0.012）和 M1 段闭塞长度（比值比，0.82；95%置信区间，0.73-0.92；P=0.0007），最佳截断值为 12mm（灵敏度 0.67；特异性 0.71），是再通的显著独立预测因素。25 例（31%）患者获得良好结局（改良 Rankin 量表 0-2 分），基线国立卫生研究院卒中量表（比值比，0.82；95%置信区间，0.72-0.93；P=0.003）和 M1 段闭塞长度（比值比，0.79；95%置信区间，0.69-0.91；P=0.0008），最佳截断值为 11mm（灵敏度 0.74；特异性 0.76），是良好结局的显著独立预测因素。
大脑中动脉闭塞的长度是 IV-tPA 治疗成功的独立预测因素。
