Department of Clinical Neurosciences, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
Department of Clinical Neurosciences, Institute of Medical Biosciences, Tokushima University, Tokushima, Japan.
J Clin Neurosci. 2019 Dec;70:67-71. doi: 10.1016/j.jocn.2019.08.078. Epub 2019 Aug 21.
Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients due to emergent large vessel occlusion (ELVO) is standard treatment, the benefits, however, are highly time-sensitive. After patient eligibility for reperfusion therapy is determined by conventional radiological examinations, the time to be transferred from the department of radiological examination to angiography-suites is critical. We speculated that the time required for the diagnosis of AIS might be reduced if we could determine MT eligibility in patients with ELVO at angiography-suites. Modern angiography-suites with flat panel detectors can perform cone beam (CB)-CT. We performed CB-CTA using intravenous injection of contrast agent to evaluate occlusion sites, collateral score, and construction of vessels distal to occlusion sites and determined if CB-CTA could be useful to evaluate patients with ELVO.
We included 15 patients with ELVO diagnosed by conventional MRI or CT/CTA, and investigated whether CB-CTA was reliable to diagnose occlusion sites. We also studied if collateral score on CB-CTA was associated with prognosis after successful reperfusion by MT by comparison between favorable (modified Rankin scale (mRS) 0-2), and unfavorable outcome group (mRS 3-6).
There was strong agreement of occlusion sites between CB-CTA and conventional radiological examination (κ = 0.80). Collateral score determined by CB-CTA was significantly different between favorable outcome and unfavorable outcome group (median collateral score 2.3 v.s. 1.3, p = 0.040).
Although prospective study of AIS patients at a radiography department is indispensable, CB-CTA performed in an angiography-suite might be useful to evaluate patients with ELVO.
对于由于大血管闭塞（ELVO）导致的急性缺血性脑卒中（AIS）患者，机械血栓切除术（MT）是标准治疗方法，但其获益具有高度的时间敏感性。在通过常规影像学检查确定患者适合再灌注治疗后，从放射科到血管造影室的转移时间至关重要。我们推测，如果我们能够在血管造影室确定 ELVO 患者的 MT 适应证，那么 AIS 的诊断所需时间可能会缩短。配备平板探测器的现代血管造影室可以进行锥形束（CB）-CT。我们通过静脉注射造影剂进行 CB-CTA，以评估闭塞部位、侧支评分以及闭塞部位远端血管的结构，并确定 CB-CTA 是否可用于评估 ELVO 患者。
我们纳入了 15 例由常规 MRI 或 CT/CTA 诊断为 ELVO 的患者，研究了 CB-CTA 是否可用于可靠诊断闭塞部位。我们还通过比较成功再灌注后预后良好（改良 Rankin 量表（mRS）0-2）和预后不良组（mRS 3-6），研究了 CB-CTA 上的侧支评分与 MT 后再灌注成功的预后是否相关。
CB-CTA 与常规影像学检查在闭塞部位上具有高度一致性（κ=0.80）。CB-CTA 确定的侧支评分在预后良好组和预后不良组之间有显著差异（中位数侧支评分 2.3 v.s. 1.3，p=0.040）。
尽管在放射科对 AIS 患者进行前瞻性研究是必不可少的，但在血管造影室进行 CB-CTA 可能有助于评估 ELVO 患者。
