Tan Jessica, Aysenne Aimee, Singh Vineeta
Department of Radiology and Biomedical Imaging, University of California, San Francisco.
Department of Clinical Neurosciences, Tulane University, New Orleans, LA.
J Neuroimaging. 2017 Jan;27(1):50-58. doi: 10.1111/jon.12392. Epub 2016 Sep 21.
Administration of intravenous tissue plasminogen activator (tPA) in the computed tomography (CT) scanner has been recently implemented at our institution, as a means to decrease door-to-needle time. This change in protocol provided us a unique opportunity to visualize imaging signs of early recanalization.
We evaluated patients who presented with acute ischemic stroke both before and after a change in protocol for intravenous tPA administration. We identified 10 patients who received tPA on the CT scanner and 22 patients who received tPA after CT imaging was complete. Early recanalization was defined as distal migration of thrombus or disappearance of thrombus between initial phases of imaging, large territory of diminished mean transit time on initial perfusion CT, large territory of increased cerebral blood flow on initial perfusion CT, and/or large territory of increased cerebral blood volume on initial perfusion CT. Late recanalization was defined as distal migration of thrombus or disappearance of thrombus between initial and follow-up imaging, decreased attenuation of thrombus between initial and follow-up imaging, or infarcted territory on follow-up imaging smaller than the cerebral blood volume defect on initial perfusion CT.
In the patients who received tPA on the CT scanner, 20% demonstrated imaging evidence of early recanalization and 30% demonstrated imaging evidence of late recanalization. In the patients who received tPA after CT imaging, 57% demonstrated imaging evidence of late recanalization.
Early recanalization of large-vessel occlusion after intravenous thrombolysis results in unique imaging findings.
我院最近实施了在计算机断层扫描（CT）扫描仪处静脉注射组织型纤溶酶原激活剂（tPA）的操作，以此作为缩短门到针时间的一种手段。这一方案的改变为我们提供了一个独特的机会来观察早期再通的影像学征象。
我们评估了在静脉注射tPA方案改变前后出现急性缺血性卒中的患者。我们确定了10例在CT扫描仪上接受tPA治疗的患者和22例在CT成像完成后接受tPA治疗的患者。早期再通定义为在成像的初始阶段之间血栓的远端迁移或血栓消失、初始灌注CT上平均通过时间减少的大片区域、初始灌注CT上脑血流量增加的大片区域和/或初始灌注CT上脑血容量增加的大片区域。晚期再通定义为在初始成像和随访成像之间血栓的远端迁移或血栓消失、初始成像和随访成像之间血栓密度降低，或随访成像上的梗死区域小于初始灌注CT上的脑血容量缺损。
在CT扫描仪上接受tPA治疗的患者中，20%有早期再通的影像学证据，30%有晚期再通的影像学证据。在CT成像后接受tPA治疗的患者中，57%有晚期再通的影像学证据。
静脉溶栓后大血管闭塞的早期再通会产生独特的影像学表现。
