Ohya Yuichiro, Uwatoko Takeshi, Mizokami Taichiro, Matsumoto Kenichi, Hashimoto Go, Sugimori Hiroshi
Department of Cerebrovascular Medicine, Saga-ken Medical Centre Koseikan, Saga, Japan.
Department of Cerebrovascular Medicine, Saga-ken Medical Centre Koseikan, Saga, Japan.
J Stroke Cerebrovasc Dis. 2020 May;29(5):104714. doi: 10.1016/j.jstrokecerebrovasdis.2020.104714. Epub 2020 Feb 22.
When introducing a microguidewire into an occluded vessel during mechanical thrombectomy (MT), visual information on the vessel course distal to the occluded site could help to avoid perforation. We examined whether visualization of the middle cerebral artery (MCA) by coronal images of nonenhanced computed tomography (coronal CT) provides useful preoperative information on the vessel course in the setting of MT.
We retrospectively studied 29 patients with ischemic stroke of the internal carotid artery and MCA occlusion who were admitted to our hospital within 4.5 hours from stroke onset and underwent MT. Coronal CT images were preoperatively created by a dedicated workstation and adjusted to visualize the M1 segment of the MCA (M1) and nearby areas. We referred to these images while performing MT. The shape and course of M1 on preoperative coronal CT images were compared with that in intraoperative angiography after recanalization. The median time from the start of imaging to arterial puncture was 40 minutes (interquartile range: 32.5-55.0 minutes). Successful recanalization of the thrombolysis in cerebral infarction 2b-3 was achieved in 89.7% of patients. The degree of matching was assessed as moderate to excellent, and was useful as preoperative information in 27 (93.1%) patients.
Preoperative information on the vessel course by coronal CT well matched that in the intraoperative angiography. Only a little extra time and a small additional procedure are necessary for this technique. The addition of coronal CT images could contribute to a safe and successful MT.
在机械取栓（MT）过程中将微导丝引入闭塞血管时，闭塞部位远端血管走行的视觉信息有助于避免穿孔。我们研究了非增强计算机断层扫描（CT）冠状图像对大脑中动脉（MCA）的可视化是否能为MT提供有关血管走行的有用术前信息。
我们回顾性研究了29例颈内动脉缺血性卒中和MCA闭塞的患者，这些患者在卒中发作后4.5小时内入院并接受了MT。术前通过专用工作站生成CT冠状图像，并进行调整以可视化MCA的M1段（M1）及附近区域。在进行MT时我们参考了这些图像。将术前CT冠状图像上M1的形状和走行与再通后术中血管造影的情况进行比较。从开始成像到动脉穿刺的中位时间为40分钟（四分位间距：32.5 - 55.0分钟）。89.7%的患者实现了脑梗死2b - 3级溶栓的成功再通。匹配程度评估为中度至优秀，对27例（93.1%）患者作为术前信息有用。
CT冠状图像提供的术前血管走行信息与术中血管造影情况匹配良好。该技术仅需少量额外时间和小的额外操作。增加CT冠状图像有助于MT安全、成功地进行。
