急性缺血性卒中前瞻性血管内治疗：非增强头颅CT与CT灌注成像的对比研究（请勿使用CTP）
Prospective Endovascular Treatment in Acute Ischemic Stroke Evaluating Non-Contrast Head CT versus CT Perfusion (PLEASE No CTP).
作者信息
Hassan Ameer E, Shamim Hafsah, Zacharatos Haralabos, Chaudhry Saqib A, Sanchez Christina, Tekle Wondwossen G, Sanchez Olive, Abantao Erlinda, Qureshi Adnan I
机构信息
Valley Baptist Medical Center, Harlingen, Texas, USA.
Department of Neurology, University of Texas Rio Grande Valley, Edinburg, Texas, USA.
出版信息
Interv Neurol. 2020 Jan;8(2-6):116-122. doi: 10.1159/000496615. Epub 2019 Feb 28.
BACKGROUND
Studies have shown a lack of agreement of computed tomography perfusion (CTP) in the selection of acute ischemic stroke (AIS) patients for endovascular treatment.
PURPOSE
To demonstrate whether non-contrast computed tomography (CT) within 8 h of symptom onset is comparable to CTP imaging.
METHODS
Prospective study of consecutive anterior circulation AIS patients with a National Institute of Health Stroke Scale (NIHSS) score > 7 presenting within 8 h of symptom onset with endovascular treatment. All patients had non-contrast CT, CT angiography, and CTP. The neuro-interventionalist was blinded to the results of the CTP and based the treatment decision using the Alberta Stroke Program Early CT score (ASPECTS). Baseline demographics, co-morbidities, and baseline NIHSS scores were collected. Outcomes were modified Rankin scale (mRS) score at discharge and in-hospital mortality. Good outcomes were defined as a mRS score of 0-2.
RESULTS
283 AIS patients were screened for the trial, and 119 were enrolled. The remaining patients were excluded for: posterior circulation stroke, no CTP performed, could not obtain consent, and NIHSS score < 7. Mean -NIHSS score at admission was 16.8 ± 3, and mean ASPECTS was 8.4 ± 1.4. There was no statistically significant correlation with CTP penumbra and good outcomes: 50 versus 47.8% with no penumbra present ( = 0.85). In patients without evidence of CTP penumbra, there was 22.5% mortality compared to 22.1% mortality in patients with a CTP penumbra. If ASPECTS ≥7, 64.6% had good outcome versus 13.3% if ASPECTS < 7 ( < 0.001). Patients with an ASPECTS ≥7 had 10% mortality versus 51.4% in patients with an ASPECTS < 7 ( < 0.001).
CONCLUSIONS
CTP penumbra did not identify patients who would benefit from endovascular treatment when patients were selected with non-contrast CT ASPECTS ≥7. There is no correlation of CTP penumbra with good outcomes or mortality. Larger prospective trials are warranted to justify the use of CTP within 6 h of symptom onset.
背景
研究表明，在选择急性缺血性卒中（AIS）患者进行血管内治疗时，计算机断层扫描灌注（CTP）结果存在差异。
目的
证明症状发作8小时内的非增强计算机断层扫描（CT）是否与CTP成像效果相当。
方法
对症状发作8小时内就诊、美国国立卫生研究院卒中量表（NIHSS）评分>7且拟进行血管内治疗的连续性前循环AIS患者进行前瞻性研究。所有患者均接受了非增强CT、CT血管造影和CTP检查。神经介入医生对CTP结果不知情，使用阿尔伯塔卒中项目早期CT评分（ASPECTS）做出治疗决策。收集患者的基线人口统计学资料、合并症和基线NIHSS评分。结局指标为出院时的改良Rankin量表（mRS）评分和住院死亡率。良好结局定义为mRS评分为0 - 2分。
结果
283例AIS患者被纳入试验筛选，119例患者被纳入研究。其余患者因以下原因被排除：后循环卒中、未进行CTP检查、无法获得知情同意以及NIHSS评分<7。入院时平均NIHSS评分为16.8±3分，平均ASPECTS评分为8.4±1.4分。CTP半暗带与良好结局之间无统计学显著相关性：无半暗带者为50%，有半暗带者为47.8%（P = 0.85）。在无CTP半暗带证据的患者中，死亡率为22.5%，而有CTP半暗带的患者死亡率为22.1%。若ASPECTS≥7，64.6%的患者结局良好；若ASPECTS<7，则为13.3%（P< = 0.001）。ASPECTS≥7的患者死亡率为10%，而ASPECTS<7的患者死亡率为51.4%（P< = 0.001）。
结论
当根据非增强CT的ASPECTS≥7选择患者时，CTP半暗带无法识别能从血管内治疗中获益的患者。CTP半暗带与良好结局或死亡率无关。需要进行更大规模的前瞻性试验，以证明在症状发作6小时内使用CTP的合理性。
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