基于影像学选择卒中发病后6~24 h行血管内血栓切除术的患者:血管造影侧支循环状况与灌注-弥散加权成像不匹配筛选的比较  

Selection of patients undergoing intravascular thrombectomy 6 to 24 hours after the onset of stroke based on imaging: a comparison of angiographic collateral circulation status and perfusion-diffusion weighted imaging mismatch screening

作　　者：刘君鹏[1] 李永坤[1] 庄文锦[1] 杨抒洁 汪银洲[1] Liu Junpeng;Li Yongkun;Zhuang Wenjin;Yang Shujie;Wang Yinzhou(Department of Neurology,Fujian Provincial Hospital,Provincial Clinical College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院神经内科,福州350001

出　　处：《国际脑血管病杂志》2020年第11期813-820,共8页International Journal of Cerebrovascular Diseases

摘　　要：目的以脑血管造影侧支循环作为评估急性大血管闭塞所致缺血性卒中(acute ischemic stroke due to large vessel occlusion,AIS-LVO)发病后6~24 h行血管内血栓切除术(endovascular thrombectomy,EVT)的筛选方法,比较其与灌注加权成像(perfusion-weighted imaging,PWI)-弥散加权成像(diffusion-weighted imaging,DWI)不匹配方法的有效性以及安全性。方法回顾性纳入福建省立医院神经内科2019年1月至2020年5月期间在发病后6~24 h接受EVT治疗的AIS-LVO患者。根据EVT筛选方法,将患者分为侧支循环筛选组和PWI-DWI筛选组。侧支循环筛选组为术前没有条件行脑灌注检查,基于数字减影血管造影(digital subtraction angiography,DSA)ASITN/SIR标准选取分级为2~4级的侧支循环良好患者;PWI-DWI筛选组为术前行PWI+DWI检查,通过PWI-DWI不匹配选取存在缺血半暗带的患者。通过术后出血性转化以及有症状颅内出血发生率评估其安全性,通过术后90 d改良Rankin量表评分明确其作为评估方法的有效性,>2分定义为转归不良。结果共纳入在发病后6~24 h接受EVT治疗的AIS-LVO患者61例,年龄(68.15±6.98)岁,男性39例(63.9%),基线美国国立卫生研究院卒中量表评分(20.33±7.84)分。侧支循环筛选组37例(60.7%),PWI-DWI筛选组24例(39.3%)。术后90 d时转归良好35例(57.4%),转归不良26例(42.6%)。侧支循环筛选组与PWI-DWI筛选组人口统计学、血管危险因素、基线临床资料、发病至EVT时间、尝试取栓次数、血管成功再通率、出血性转化和有症状颅内出血发生率以及90 d时临床转归均差异无统计学意义。多变量logistic回归分析显示,中重度卒中(基线美国国立卫生研究院卒中量表评分16~20分:优势比11.649,95%可信区间3.396~39.962;P<0.001)以及取栓次数≥3次(优势比3.314;95%可信区间1.011~10.867;P=0.048)与转归不良独立相关。结论对于发病后6~24 h的AIS-LVO患者,如果不能进行颅脑PWI+DWI检查,可根据DSA侧�Objective To compare the effectiveness and safety of angiographic collateral circulation status and perfusion-diffusion mismatch(PDM)used as a screening method for endovascular thrombectomy(EVT)6-24 h after the onset of acute ischemic stroke due to large vessel occlusion(AIS-LVO).Methods Patients with AIS-LVO treated with EVT 6 to 24 h after onset in the Department of Neurology,Fujian Provincial Hospital from January 2019 to May 2020 were enrolled retrospectively.According to the EVT screening methods,the patients were divided into collateral circulation screening group and PDM screening group.In the collateral circulation screening group,patients with good collateral circulation grades 2 to 4 were selected based on the ASITN/SIR criteria of cerebral angiography;in the PDM screening group,patients with ischemic penumbra were selected by PDM.The safety was evaluated by the incidence of postoperative hemorrhagic transformation and symptomatic intracranial hemorrhage(sICH),and its effectiveness was evaluated by the modified Rankin Scale score at 90 d after operation.A score of>2 was defined as poor outcome.Results A total of 61 patients with AIS-LVO treated with EVT 6-24 h after onset were enrolled in the study.Their age was 68.15±6.98 years,39 were male(63.9%),and the baseline National Institutes of Health Stroke Scale(NIHSS)score was 20.33±7.84.There were 37 patients(60.7%)in collateral circulation screening group and 24(39.3%)in PDM screening group.At 90 d after operation,35 patients(57.4%)had a good outcome and 26(42.6%)had a poor outcome.There were no statistically significant differences in demographics,vascular risk factors,baseline clinical data,the time from onset to EVT,number of thrombectomy attempts,successful recanalization rate,incidence of hemorrhagic transformation and sICH,and clinical outcome at 90 d between the two groups.Multivariate logistic regression analysis showed that moderate to severe stroke(baseline NIHSS score 16-20:odds ratio 11.649,95%confidence interval 3.396-39.962;P<0.001)and the

关 键 词：卒中 脑缺血 血管内手术 血栓切除术 脑血管造影术 磁共振成像 侧支循环 治疗结果 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651.12[医药卫生—诊断学]