Vanicek Jiri, Cimflova Petra, Bulik Martin, Jarkovsky Jiri, Prelecova Veronika, Szeder Viktor, Volny Ondrej
Department of Medical Imaging, St. Anne´s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Department of Medical Imaging, St. Anne´s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Centre, Stroke Research Program, St. Anne´s University Hospital, Brno, Czech Republic.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):1085-1092. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.041. Epub 2019 Jan 14.
In randomized clinical trials, mechanical thrombectomy (MT) was proved to be a highly effective treatment of acute ischemic stroke which improved clinical outcomes. Some of the trials used automated computed tomography perfusion (CTP) analysis for selection of participants. We present a single-center experience with CTP selection and comparison with CTP trials.
Data of consecutive MT patients (from January 2016 to December 2017) were retrospectively reviewed. All patients with multiphase CT angiography confirmed the presence of anterior circulation large vessel occlusion/s in the intracranial internal carotid artery and/or middle cerebral artery (M1 or M2) and with admission brain CTP analyzed by RAPID software were included into the analysis.
Sixty-two patients fulfilled the inclusion criteria (mean age was 70.1 ± 13.6 years, females 48.5%). At baseline, National Institutes of Health Stroke Scale score was 16 (IQR = 13-20), Alberta Stroke Program Early CT Score (ASPECTS) was 8 (IQR = 7-9), CTP core volume was 20 mL (IQR = 2-36), and CTP penumbra volume was 145.5 mL (IQR = 107-184). Time from stroke onset to imaging was 1 hour 32 minutes, time from stroke onset to reperfusion was 3 hours 50 minutes, and median time from CT to reperfusion was 1 hour 56 minutes. Modified thrombolysis in cerebral infarction 2b/3 was achieved in 42 patients (67.7%). Twenty-three patients (37%) had modified Rankin scale 0-2 at 90 days.
Our analysis of CTP-selected patients for MT supports clinical applicability of automated CTP analysis into everyday clinical practice.
在随机临床试验中，机械取栓术（MT）被证明是治疗急性缺血性卒中的一种高效疗法，可改善临床预后。部分试验采用自动计算机断层扫描灌注（CTP）分析来选择参与者。我们介绍了单中心使用CTP选择的经验，并与CTP试验进行比较。
回顾性分析连续MT患者（2016年1月至2017年12月）的数据。纳入所有经多期CT血管造影证实颅内颈内动脉和/或大脑中动脉（M1或M2）存在前循环大血管闭塞且入院时脑CTP由RAPID软件分析的患者进行分析。
62例患者符合纳入标准（平均年龄70.1±13.6岁，女性占48.5%）。基线时，美国国立卫生研究院卒中量表评分为16（四分位间距[IQR]=13 - 20），阿尔伯塔卒中项目早期CT评分（ASPECTS）为8（IQR=7 - 9），CTP核心体积为20 mL（IQR=2 - 36），CTP半暗带体积为145.5 mL（IQR=107 - 184）。从卒中发作到成像的时间为1小时32分钟，从卒中发作到再灌注的时间为3小时50分钟，从CT到再灌注的中位时间为1小时56分钟。42例患者（67.7%）实现了改良脑梗死溶栓2b/3级。23例患者（37%）在90天时改良Rankin量表评分为0 - 2级。
我们对CTP选择的MT患者的分析支持将自动CTP分析应用于日常临床实践。
