Song Kangping, Guan Min, Li Wenxian, Jing Zhen, Xie Xiaomei, Shi Changzheng, Liang Jianye, Qiao Hongyu, Huang Li'an
Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.
Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.
Neuroradiology. 2019 Apr;61(4):451-459. doi: 10.1007/s00234-019-02177-1. Epub 2019 Feb 6.
The recommendation strength of the guidelines for mechanical thrombectomy among patients with large pre-treatment core infarct is weak. We evaluated the safety and outcome of endovascular treatment for acute ischemic stroke with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) ≤ 5.
Data on acute ischemic stroke patients with DWI-ASPECTS ≤ 5 who underwent endovascular treatment within 6 h, or presented an arterial spin labeling-DWI (ASL-DWI) mismatch within 12 h, at our center were retrospectively collected. We report the clinical characteristics and outcome of every patient, and review the relevant literature.
Among the 19 patients who were enrolled, all experienced successful reperfusion, and 10 achieved a favorable outcome (modified Rankin scale (mRS) ≤ 2). Two patients presented with symptomatic intracranial hemorrhage (sICH); both of them had a poor outcome (mRS > 2).
Acute ischemic stroke patients with large DWI lesions caused by large vessel occlusion can achieve a favorable clinical outcome with endovascular treatment if recanalization is performed within 6 h, or after 6 h in case of an ASL-DWI mismatch.
对于治疗前核心梗死面积较大的患者，机械取栓指南的推荐力度较弱。我们评估了弥散加权成像-艾伯塔卒中项目早期计算机断层扫描评分（DWI-ASPECTS）≤5的急性缺血性卒中患者进行血管内治疗的安全性和疗效。
回顾性收集在我们中心接受血管内治疗的DWI-ASPECTS≤5的急性缺血性卒中患者的数据，这些患者在6小时内接受了血管内治疗，或在12小时内出现动脉自旋标记-DWI（ASL-DWI）不匹配。我们报告每位患者的临床特征和疗效，并回顾相关文献。
在纳入的19例患者中，所有患者均成功再灌注，10例患者获得良好预后（改良Rankin量表（mRS）≤2）。2例患者出现症状性颅内出血（sICH）；这2例患者预后均较差（mRS>2）。
由大血管闭塞引起的DWI病变较大的急性缺血性卒中患者，如果在6小时内进行再通，或在ASL-DWI不匹配的情况下在6小时后进行再通，血管内治疗可获得良好的临床疗效。
