Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC, 3050, Australia.
Curr Neurol Neurosci Rep. 2019 Jul 6;19(8):57. doi: 10.1007/s11910-019-0970-7.
Urgent reperfusion treatment with intravenous thrombolysis or mechanical thrombectomy reduces disability after ischaemic stroke. Imaging plays an important role in identifying patients who benefit, particularly in extended time windows. However, the role of post-treatment neuroimaging is less well established. We review recent advances in neuroimaging after reperfusion treatment and provide a practical guide to the options and management implications.
Post-treatment imaging is critical to identify patients with reperfusion-related haemorrhage and oedema requiring intervention. It also can guide the timing and intensity of antithrombotic medication. The degree of reperfusion on post-thrombectomy angiography and infarct volume and topography using CT or MRI carry important prognostic significance. Perfusion-weighted MRI and permeability analysis may help detect persistent perfusion abnormalities post-treatment and predict haemorrhagic complications. Post-treatment neuroimaging provides clinically relevant information to identify complications, assess prognosis and perform quality assurance after acute ischaemic stroke. Recent advances in neuroimaging represent a potential avenue to explore post-reperfusion pathophysiology and uncover therapeutic targets for secondary ischaemic and haemorrhagic injury.
静脉溶栓或机械取栓的紧急再灌注治疗可降低缺血性脑卒中后的残疾程度。影像学在识别获益患者方面发挥着重要作用，特别是在延长的时间窗内。然而，再灌注治疗后神经影像学的作用尚不完全明确。我们综述了再灌注治疗后神经影像学的最新进展，并提供了实用的选择和管理建议。
治疗后影像学检查对于识别需要干预的再灌注相关出血和水肿患者至关重要。它还可以指导抗血栓药物的时机和强度。经皮血管内治疗后的血管造影再灌注程度、CT 或 MRI 上的梗死体积和分布具有重要的预后意义。灌注加权 MRI 和通透性分析有助于检测治疗后的持续灌注异常，并预测出血并发症。治疗后神经影像学提供了与并发症识别、预后评估和急性缺血性脑卒中后质量保证相关的临床相关信息。神经影像学的最新进展代表了探索再灌注后病理生理学和发现继发性缺血和出血损伤治疗靶点的潜在途径。
