Cheng B, Broocks G
Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland.
Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland.
Nervenarzt. 2021 Aug;92(8):733-743. doi: 10.1007/s00115-021-01121-0. Epub 2021 May 10.
In ischemic stroke due to large vessel occlusion (LVO), the indications for patient selection for endovascular mechanical thrombectomy (MT) are based on findings from brain imaging. Several imaging protocols from computed tomography (CT) or magnetic resonance imaging (MRI) are available to guide treatment decisions.
To recommend the optimal choice of imaging modalities and protocols for MT with respect to time windows from symptom onset.
Evaluation of the results of large randomized placebo-controlled trials regarding imaging-based patient selection in MT categorized by time intervals since symptom onset. We discuss methodological aspects, advantages and caveats of individual stroke imaging protocols. Summary of recommendations for the practice.
In MT trials CT was mostly used for patient selection. Plain CT combined with CT angiography or additional perfusion imaging is the preferred option. In early time windows CT with CTA is adequate (≤ 6 h for MT, ≤ 4.5 h in cases of accompanying thrombolysis according to exclusion criteria). In later or unknown time windows perfusion imaging is needed for patient selection. Patients presenting with unknown time windows should be examined by MRI as a first-line choice in mild to moderate deficits, in cases of severe deficits CT imaging with perfusion imaging.
在因大血管闭塞（LVO）导致的缺血性卒中中，血管内机械取栓术（MT）患者选择的指征基于脑成像结果。有几种来自计算机断层扫描（CT）或磁共振成像（MRI）的成像方案可用于指导治疗决策。
根据症状发作后的时间窗，推荐MT成像方式和方案的最佳选择。
评估大型随机安慰剂对照试验的结果，这些试验涉及根据症状发作后的时间间隔对MT中基于成像的患者选择进行分类。我们讨论了各个卒中成像方案的方法学方面、优点和注意事项。对实践建议进行总结。
在MT试验中，CT大多用于患者选择。平扫CT联合CT血管造影或额外的灌注成像为首选方案。在早期时间窗，CT血管造影（CTA）就足够了（MT为≤6小时，根据排除标准，伴有溶栓时为≤4.5小时）。在较晚或未知时间窗，患者选择需要灌注成像。时间窗未知的患者，若为轻至中度缺损，应以MRI作为一线检查；若为严重缺损，则应进行CT成像及灌注成像检查。
