Menon Bijoy K, Campbell Bruce C V, Levi Christopher, Goyal Mayank
From the Calgary Stroke Program and the Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (B.K.M., M.G.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C.); and Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia (C.L.).
Stroke. 2015 Jun;46(6):1453-61. doi: 10.1161/STROKEAHA.115.009160. Epub 2015 May 5.
Ischemic stroke is caused by a thrombus that blocks an intracranial artery. Brain tissue beyond the blocked artery survives for a variable period of time because of blood and nutrients received through tiny vessels called collaterals. Imaging the brain and the vasculature that supplies it is therefore a vital first step in treating patients with acute ischemic stroke. In this review, we focus on current evidence for imaging selection of patients for endovascular therapy in the context of the recently positive clinical trials, such as Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing Computed Tomography to Recanalization Times (ESCAPE), Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME), and Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA). We discuss evidence for and use of the various imaging paradigms available. We discuss how to set up quick and efficient imaging protocols for patient selection and address common concerns about the use of imaging, including time spent, contrast, radiation, and other advantages and disadvantages. Finally, we briefly comment on how imaging can integrate itself within various health systems of care in the future, thereby potentially improving patient outcomes further.
缺血性中风是由血栓阻塞颅内动脉引起的。由于通过称为侧支的微小血管获得血液和营养，阻塞动脉远端的脑组织会存活一段时间。因此，对大脑及其供血血管系统进行成像，是治疗急性缺血性中风患者至关重要的第一步。在这篇综述中，我们聚焦于在近期一些阳性临床试验背景下，对患者进行血管内治疗成像选择的现有证据，这些试验包括荷兰急性缺血性中风血管内治疗多中心随机临床试验（MR CLEAN）、强调最小化计算机断层扫描至再通时间的小核心梗死和前循环近端闭塞血管内治疗（ESCAPE）、以血栓切除术为主要血管内治疗手段的Solitaire（SWIFT PRIME）以及延长急性神经功能缺损动脉内溶栓时间（EXTEND-IA）。我们讨论了现有各种成像模式的证据及应用。我们探讨了如何为患者选择建立快速有效的成像方案，并解决有关成像使用的常见问题，包括所花费的时间、造影剂、辐射以及其他优缺点。最后，我们简要评论了成像在未来如何融入各种医疗保健系统，从而有可能进一步改善患者预后。
