静脉注射组织型纤溶酶原激活剂（IV tPA）后的早期再灌注率由CTA血栓特征决定。
Early reperfusion rates with IV tPA are determined by CTA clot characteristics.
作者信息
Mishra S M, Dykeman J, Sajobi T T, Trivedi A, Almekhlafi M, Sohn S I, Bal S, Qazi E, Calleja A, Eesa M, Goyal M, Demchuk A M, Menon B K
机构信息
From the Departments of Clinical Neurosciences (S.M.M., T.T.S., A.T., M.A., E.Q., M.E., M.G., A.M.D., B.K.M.).
Radiology (J.D., M.A., M.E., M.G., A.M.D., B.K.M.).
出版信息
AJNR Am J Neuroradiol. 2014 Dec;35(12):2265-72. doi: 10.3174/ajnr.A4048. Epub 2014 Jul 24.
BACKGROUND AND PURPOSE
An ability to predict early reperfusion with IV tPA in patients with acute ischemic stroke and intracranial clots can help clinicians decide if additional intra-arterial therapy is needed or not. We explored the association between novel clot characteristics on baseline CTA and early reperfusion with IV tPA in patients with acute ischemic stroke by using classification and regression tree analysis.
MATERIALS AND METHODS
Data are from patients with acute ischemic stroke and proximal anterior circulation occlusions from the Calgary CTA data base (2003-2012) and the Keimyung Stroke Registry (2005-2009). Patients receiving IV tPA followed by intra-arterial therapy were included. Clot location, length, residual flow within the clot, ratio of contrast Hounsfield units pre- and postclot, and the M1 segment origin to the proximal clot interface distance were assessed on baseline CTA. Early reperfusion (TICI 2a and above) with IV tPA was assessed on the first angiogram.
RESULTS
Two hundred twenty-eight patients (50.4% men; median age, 69 years; median baseline NIHSS score, 17) fulfilled the inclusion criteria. Median symptom onset to IV tPA time was 120 minutes (interquartile range = 70 minutes); median IV tPA to first angiography time was 70.5 minutes (interquartile range = 62 minutes). Patients with residual flow within the clot were 5 times more likely to reperfuse than those without it. Patients with residual flow and a shorter clot length (≤15 mm) were most likely to reperfuse (70.6%). Patients with clots in the M1 MCA without residual flow reperfused more if clots were distal and had a clot interface ratio in Hounsfield units of <2 (36.8%). Patients with proximal M1 clots without residual flow reperfused 8% of the time. Carotid-T/-L occlusions rarely reperfused (1.7%). Interrater reliability for these clot characteristics was good.
CONCLUSIONS
Our study shows that clot characteristics on CTA help physicians estimate a range of early reperfusion rates with IV tPA.
背景与目的
预测急性缺血性卒中合并颅内血栓患者静脉注射组织型纤溶酶原激活剂（IV tPA）后早期再灌注的能力，有助于临床医生决定是否需要额外的动脉内治疗。我们通过分类与回归树分析，探讨了急性缺血性卒中患者基线CT血管造影（CTA）上新的血栓特征与IV tPA早期再灌注之间的关联。
材料与方法
数据来自卡尔加里CTA数据库（2003 - 2012年）和庆熙大学卒中登记处（2005 - 2009年）中患有急性缺血性卒中和近端前循环闭塞的患者。纳入接受IV tPA治疗后再行动脉内治疗的患者。在基线CTA上评估血栓位置、长度、血栓内残余血流、血栓前后对比剂亨氏单位比值以及M1段起始点至近端血栓界面的距离。在首次血管造影时评估IV tPA后的早期再灌注情况（脑梗死溶栓分级（TICI）2a及以上）。
结果
228例患者（男性占50.4%；中位年龄69岁；基线美国国立卫生研究院卒中量表（NIHSS）评分中位数为17分）符合纳入标准。症状发作至IV tPA的中位时间为120分钟（四分位间距 = 70分钟）；IV tPA至首次血管造影的中位时间为70.5分钟（四分位间距 = 62分钟）。血栓内有残余血流的患者再灌注的可能性是无残余血流患者的5倍。有残余血流且血栓长度较短（≤15 mm）的患者最有可能再灌注（70.6%）。M1段大脑中动脉（MCA）有血栓且无残余血流的患者，如果血栓位于远端且血栓界面亨氏单位比值<2，则再灌注的比例更高（36.8%）。M1段近端有血栓且无残余血流的患者再灌注率为8%。颈动脉T/-L闭塞很少再灌注（1.7%）。这些血栓特征的观察者间可靠性良好。
结论
我们的研究表明，CTA上的血栓特征有助于医生评估IV tPA早期再灌注率的范围。
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