Stroke:大血管闭塞性脑卒中并ASPECT评分≥6分的患者要不要做介入治疗?

2020-03-06 shaosai MedSci原创

本研究假说在CT上显示急性缺血状态的患者中,发病时软脑膜侧支循环功能能够预测磁共振上脑梗死大小。本研究旨在评价大血管闭塞性脑梗死患者侧支循环功能与扩散加权成像(DWI)上定义的脑梗死体积系列变化间的相关性。

背景和目的

本研究假说在CT上显示急性缺血状态的患者中,发病时软脑膜侧支循环功能能够预测磁共振上脑梗死大小。本研究旨在评价大血管闭塞性脑梗死患者侧支循环功能与扩散加权成像(DWI)上定义的脑梗死体积系列变化间的相关性。

方法

本研究纳入了准备行血管内治疗并行治疗前多期CTA(mCTA)和多模态磁共振成像的患者。利用基于mCTA和磁共振的侧支循环图来请假基线时早期缺血性变化和侧支循环功能。利用多元线性回归评价侧支循环功能指标在预测介入治疗前MR DWI病灶体积的价值。

结果

在65例患者中,分别有10 (15.4%)、8 (12.3%)和 47 (72.3%)例患者mCTA图像显示侧支循环功能为差、一般和良好。在调整最初脑卒中严重程度、ASPECTS,发病到行DWI时间和不匹配体积后,mCTA中侧支循环功能分级是与DWI体积(β=-35.657, SE mean=3.539; P<0.0001)唯一独立指标。在mCTA和基于磁共振侧支循环功能分级间具有很好的相关性(匹配达92.3%),这表明在超急性期侧支循环持续发挥作用。

结论

mCTA评价的侧支循环指标是介入治疗前预测脑梗死DWI病灶体积的唯一预测指标。对于早期缺血性改变并大血管闭塞患者侧支循环功能的评价对是否进行激进的血管再通具有额外的决策价值。

原始出处:

Yu I, Bang OY, Chung JW, et al,Admission Diffusion-Weighted Imaging Lesion Volume in Patients With Large Vessel Occlusion Stroke and Alberta Stroke Program Early CT Score of ≥6 Points: Serial Computed Tomography-Magnetic Resonance Imaging Collateral Measurements.Stroke. 2019.DOI:10.1161/STROKEAHA.119.026229

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    2020-12-16 feather89
  2. [GetPortalCommentsPageByObjectIdResponse(id=1728344, encodeId=09021e28344b4, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Wed Dec 16 08:40:00 CST 2020, time=2020-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706152, encodeId=92d61e0615205, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Mar 09 04:40:00 CST 2020, time=2020-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1780181, encodeId=4f931e80181f1, content=<a href='/topic/show?id=b30128e9b8' target=_blank style='color:#2F92EE;'>#ASPECT评分#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2879, encryptionId=b30128e9b8, topicName=ASPECT评分)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Tue Feb 02 19:40:00 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009859, encodeId=6dce200985920, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Feb 17 08:40:00 CST 2021, time=2021-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026589, encodeId=faa410265891b, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Mar 06 20:40:00 CST 2020, time=2020-03-06, status=1, ipAttribution=)]
    2020-03-09 kkunny
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    2020-03-06 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

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