改良扩散加权成像与液体衰减反转恢复序列不匹配指导下不明发病时间前循环大血管急性闭塞患者血管内治疗的研究  

Unknown-onset strokes with anterior circulation occlusion treated by thrombectomy using diffusion-weighted imaging-fluid attenuated inversion recovery modified mismatch selection

作　　者：吴迎春[1] 王俊梅[1] 孙锐[1] 冯冠青[1] Wu Yingchun;Wang Junmei;Sun Rui;Feng Guanqing(Department of Neurology,Ordos Central Hospital,Ordos,Inner Mongolia Autonomous Region 017000,China)

机构地区：[1]内蒙古自治区鄂尔多斯市中心医院神经内科,017000

出　　处：《中国脑血管病杂志》2021年第7期446-452,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：内蒙古自治区自然基金(2018MS00135)。

摘　　要：目的探讨采用改良扩散加权成像(DWI)与液体衰减反转恢复(FLAIR)序列不匹配评估不明发病时间(包括醒后卒中)的前循环大血管急性闭塞患者进行血管内治疗的安全性和有效性。方法本研究为前瞻性单中心队列研究,连续纳入2017年1月至2020年9月在鄂尔多斯市中心医院神经内科住院治疗的发病时间不明且症状发现超过6 h的前循环大血管闭塞致急性缺血性卒中患者(研究组)与发病时间明确6 h内的前循环大血管闭塞致急性缺血性卒中患者(对照组)。对照组符合静脉溶栓患者实施静脉溶栓桥接机械取栓治疗或者直接取栓治疗。研究组患者改良DWI-FLAIR不匹配(DWI阳性,FLAIR阴性或部分阳性,但病灶明显小于DWI),直接进行机械取栓治疗。血管内治疗术后即刻成功再灌注率和术后3个月改良Rankin量表(mRs)评分为主要结局指标,症状性颅内出血和死亡为次要结局指标。成功再灌注定义为闭塞远端血流达到改良脑梗死溶栓试验(mTICI)分级2b/3级;术后90 d时mRS评分≤2分定义为良好预后。应用SPSS 25.0统计学软件分析处理数据,组间比较采用两样本均数比较的t检验或两独立样本比较的秩和检验以及χ^(2)检验或Fisher确切概率法。结果最终69例接受取栓患者入选,其中研究组25例,对照组44例。59例(85.5%)患者成功实现血管再通,其中研究组21例(84.0%)和对照组38例(86.4%),组间差异无统计学意义(Fisher确切概率法:P=1.000)。69例中,9例发生症状性颅内出血,其中研究组3例(12.0%),对照组6例(13.6%),组间症状性颅内出血发生率差异无统计学意义(Fisher确切概率法:P=1.000)。随访3个月,6例患者死亡,其中研究组2例(8.0%),对照组4例(9.1%),组间差异无统计学意义(Fisher确切概率法:P=1.000)。术后90 d总良好预后率为53.6%(37例),其中研究组为14例(56.0%),对照组为23例(52.3%),组间差异无统计学意义(χ^(2)=0.089,P=0.765)。结论采用DWI-FObjective To evaluate the efficacy and safety of thrombectomy for unknown-onset strokes(UOS,including wake-up stroke)based on modified diffusion-weighted imaging(DWI)-fluid attenuated inversion recovery(FLAIR)mismatch selection.Methods From January 2017 to September 2020,consecutive UOS receiving thrombectomy in the Department of Neurology,Ordos Central Hospital were enrolled in this prospective cohort study.UOS with proximal anterior circulation occlusion discovered beyond 6 hours from"last seen normal"(research group)were compared with known-onset strokes(KOS)within 6 hours from onset(control group).The patients with intravenous thrombolysis in the control group underwent the intravenous thrombolysis bridging mechanical thrombectomy or direct thrombectomy.The patients with modified DWI and FLAIR mismatch(DWI showed positive,FLAIR showed negative or partially positive,but the lesions were significantly smaller than DWI)in the research group were treated with mechanical thrombectomy.Primary outcomes were successful recanalization and the modified Rankin scale(mRS)score at 3 months.Secondary outcomes were symptomatic intracranial hemorrhage and mortality.Successful recanalization was defined as blood flow of distal occlusion achieving Modified Cerebral Thrombolysis in Cerebral Infarction(mTICI)2 b/3.Good prognosis was defined as 90-day mRS≤2 postoperatively.Statistical software SPSS 25.0 was used to analyze and process the data.The Student′s t-test or rank sum test was used to compare the mean of the two independent samples,and the chi-square test or Fisher′s exact probability method was also used.Results Sixty-nine patients accepted endovascular thrombectomy were enrolled in the study,including 25 UOS and 44 KOS.Successful recanalization was achieved in 59 patients(85.5%),including 21 patients(84.0%)in research group and 38 patients(86.4%)in control group,and the difference was not statistically significant(Fisher exact probability test:P=1.000).Of the 69 cases,9 had symptomatic intracerebral hemorrhage,inc

关 键 词：醒后卒中 发病时间不明卒中 急性缺血性卒中 机械取栓 改良扩散加权成像与液体衰减反转恢复序列不匹配 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]