From the Department of Neurology (A.M., A.S., O.C.S.), University Hospital Frankfurt, Goethe University, Germany.
Department of Neurology; University Medical Center of the Johannes Gutenberg University Mainz, Germany (A.M.).
Stroke. 2019 Nov;50(11):3274-3276. doi: 10.1161/STROKEAHA.119.025973. Epub 2019 Sep 9.
Background and Purpose- Patients with large-vessel stroke frequently need to be transferred to comprehensive stroke centers for endovascular treatment. An update of physiological perfusion parameters and stroke progression on arrival is desirable. We examined the reliability of preinterventional pooled blood volume (PBV)-maps acquired by flat-panel detector computed tomography (CT) in the interventional angiography suite. Methods- The volumes of preinterventional perfusion deficit in flat-panel detector CT-PBV source images were compared with final infarct volume on follow-up multislice-CT after endovascular treatment of 29 consecutive patients with occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA). Results- Endovascular treatment was successful in 26 patients (Thrombolysis in Cerebral Infarction, 2b-3). Overall, the median preinterventional PBV-deficit was 9×larger than median final infarct volume on multislice-CT (86.4 mL [10.3; 111.6] versus 9.6 mL [3.6; 36.8]). This was especially evident in the subgroup of successful recanalization (PBV-deficit: 87.5 mL [10.6; 115.1], final infarct: 8.7 mL [3.6; 29]). In futile recanalization, the final infarct tended to be underestimated (PBV-deficit: 86.4 mL [5.9; -] and final infarct: 116.4 mL [3.5; -]). Conclusions- Flat panel detector CT-PBV is not reliable in predicting the final infarct volume and should not be used in clinical decision making for endovascular treatment of acute cerebral artery occlusions.
背景与目的- 大血管卒中患者经常需要转至综合卒中中心进行血管内治疗。在到达时更新生理灌注参数和卒中进展的情况是可取的。我们检查了在介入血管造影室获得的平板探测器 CT （CT）平扫时的全脑血容量（PBV）图的可靠性。
方法- 将平板探测器 CT 源图像上的平扫时灌注缺损体积与 29 例大脑中动脉（MCA）或颈内动脉（ICA）远端闭塞患者血管内治疗后随访的多层螺旋 CT 上的最终梗死体积进行比较。
结果- 26 例患者血管内治疗成功（血栓切除术治疗脑梗死，2b-3）。总的来说，平扫时 PBV 缺损中位数比多层螺旋 CT 上的最终梗死体积中位数大 9 倍（86.4 毫升[10.3；111.6]与 9.6 毫升[3.6；36.8]）。在成功再通的亚组中，这一点尤为明显（PBV 缺损：87.5 毫升[10.6；115.1]，最终梗死：8.7 毫升[3.6；29]）。在无效再通中，最终梗死体积有被低估的趋势（PBV 缺损：86.4 毫升[5.9；-]，最终梗死：116.4 毫升[3.5；-]）。
结论- 平板探测器 CT-PBV 不能可靠地预测最终梗死体积，不应在急性脑动脉闭塞血管内治疗的临床决策中使用。
