发病24至48小时急性前循环脑梗死患者CT灌注成像指导下血管内治疗的安全性和效果分析  

Safety and efficacy analysis of endovascular treatment under the guidance of CT prefusion imaging in patients with acute anterior circulation cerebral infarction onset 24-48 h

作　　者：刘文虎[1] 钟孟飞[1] 陈晓辉[1] 张立功[1] 张毓琦 唐天萍[1] 李海停[1] 吕在刚[1] 高宗恩[1] Liu Wenhu;Zhong Mengfei;Chen Xiaohui;Zhang Ligong;Zhang Yuqi;Tang Tianping;Li Haiting;Lyu Zaigang;Gao Zongen(Department of Neurology,Shengli Oilfield Central Hospital,Dongying,Shandong 257000,China)

机构地区：[1]胜利油田中心医院神经内科,山东省东营市257000

出　　处：《中国脑血管病杂志》2022年第4期230-237,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨发病24~48 h急性前循环脑梗死患者在CT灌注成像指导下进行血管内治疗的安全性和效果。方法回顾性连续纳入2019年9月至2021年3月在胜利油田中心医院神经内科行急诊血管内治疗的急性前循环闭塞性脑梗死患者143例。所有患者术前完善头部CT血管成像(CTA)或MR血管成像(MRA)检查,发病时间超过6 h患者完善CT灌注成像影像学评估,并应用eStroke国家取栓溶栓影像平台数据评估筛选。根据发病至穿刺时间的不同,将143例患者分为超窗组(31例,发病至动脉穿刺时间为24~48 h)和窗内组(112例,发病至动脉穿刺时间<24 h)。根据术后90 d改良Rankin量表(mRS)评分不同,将超窗组患者分为预后良好组(11例,mRS评分0~2分)和预后不良组(20例,mRS评分3~6分)。对比分析超窗组与窗内组患者的基线资料,比较两组患者血管再通情况[采用改良脑梗死溶栓(mTICI)分级评估,mTICI 2b~3级为血管成功再通,0~2a级为血管未再通]、术后不同时间美国国立卫生研究院卒中量表(NIHSS)评分、症状性颅内出血、术后90 d mRS评分等情况,并对比分析超窗组中预后良好组与预后不良组患者的基线资料以及血管再通情况。结果(1)超窗组平均年龄及静脉溶栓患者比例均明显小于窗内组[分别为(65±7)岁比(69±4)岁和9.7%(3/31)比31.3%(35/112)],差异均有统计学意义(t=-2.937,χ^(2)=5.791,均P<0.05);超窗组患者发病至股动脉穿刺时间[1689(1560,1920)min比564(540,580)min,Z=-8.518]、患者到院至股动脉穿刺时间[140(70,165)min比90(80,107)min,Z=-2.520]、发病至血管再通时间[1739(1610,1970)min比623(500,840)min,Z=-8.508]均高于窗内组,组间差异均有统计学意义(均P<0.05)。(2)超窗组与窗内组血管再通率[71.0%(22/31)比74.1%(83/112),χ^(2)=0.123]、症状性颅内出血[9.7%(3/31)比6.3%(7/112),χ^(2)=0.070]、NIHSS评分[术后24 h:12(7,15)分比15(8,18)分,Z=-1.694;术后7 d:9(4,12)分比9(4,14)分,Z=-0.757;术后90 d:6(1Objective To investigate the safety and efficacy of endovascular therapy under the guidance of CT perfusion(CTP)imaging for patients with acute anterior circulation cerebral infarction onset 24-48 h.Methods A total of 143 patients with acute anterior circulation occlusive stroke who received emergency endovascular treatment in the Department of Neurology,Shengli Oilfield Central Hospital from September 2019 to March 2021 were retrospectively and consecutively enrolled.All patients underwent head CT angiography(CTA)or MR angiography(MRA)examination before surgery.Patients with stroke onset beyond 6 h should undergo CT perfusion(CTP)imaging evaluation,and the images were evaluated by eStroke National Thrombolysis Imaging Platform data.According to the time from onset to puncture,143 patients were divided into two groups:ultra-window group(31 cases,24-48 h from onset to arterial puncture)and intra-window group(112 cases,<24 h from onset to arterial puncture).According to the different prognoses assessed by the modified Rankin scale score(mRS)at 90 d after operation,divided into ultra-window patients were the good prognosis group(11 cases,mRS score 0-2 points)and the poor prognosis group(20 cases,mRS score 3-6 points).The baseline data,vascular recanalization status(evaluated by modified thrombolysis in cerebral infarction[mTICI];mTICI 2 b-3 as successful recanalization and 0-2 a as unsuccessful recanalization),National Institutes of Health Stroke Scale(NIHSS)scores,symptomatic intracranial hemorrhage,mRS score at 90 d after surgery,etc.were compared between the ultra-window group and the intra-window group.Also,the baseline data and recanalization of the patients in the good prognosis group and the poor prognosis group of the ultra-window group were compared.Results(1)The mean age and proportion of patients with intravenous thrombolysis in ultra-window group were significantly lower than those in intra-window group([65±7]years vs.[69±4]years;9.7%[3/31]vs.31.3%[35/112];respectively),and the differences were statist

关 键 词：脑梗死 预后 前循环大血管闭塞 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]