急性前循环大血管闭塞性脑梗死患者机械取栓术后DSA平板头部CT对脑出血转化风险的预测作用研究  

Application of DSA flat-panel CT in predicting the risk of intracranial hemorrhage transformation after mechanical thrombectomy in patients with acute cerebral infarction caused by anterior circulation large vessel occlusion

作　　者：钟健 张帆 张茂[1] 黄荔 陶木顺 Zhong Jian;Zhang Fan;Zhang Mao;Huang Li;Tao Mushun(Department of Cerebrovascular Disease,Hainan Provincial People′s Hospital,Hainan Hospital Affiliated to Hainan Medical University,Haikou,Hainan 570311,China)

机构地区：[1]海南省人民医院(海南医学院附属海南医院)脑血管病科,海南省海口市570311

出　　处：《中国脑血管病杂志》2022年第12期824-830,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：海南省心脑血管疾病防治及急诊急救关键技术研究与应用(ZDKJ202004)。

摘　　要：目的评估急性前循环大血管闭塞性脑梗死患者行机械取栓术后即刻DSA平板头部CT对患者术后24 h脑出血转化风险的预测价值。方法回顾性分析自2019年1月至2021年8月于海南省人民医院脑血管病科连续就诊的诊断为急性前循环大血管闭塞性脑梗死并行机械取栓且术后即刻行DSA平板头部CT扫描的患者90例,所有患者机械取栓术后24 h复查头部CT以判断是否存在脑出血转化。根据术后即刻DSA平板头部CT是否存在可见的脑实质均匀性高密度影,将所有入选患者分为高密度影组(54例)和非高密度影组(36例),记录并分析两组患者基线资料及术后血管再通情况[采用改良脑梗死溶栓(mTICI)分级评价,mTICI分级≥2b级为血管成功再通]、术后3个月的临床预后[采用改良Rankin量表(mRS)评分评估,0~2分定义为预后良好,3~6分定义为预后不良]及术后24 h内脑出血转化情况(依据脑梗死后首次头部CT或MRI及再次复查头部CT或MRI检查情况评估)和症状性颅内出血发生情况,对术后DSA平板CT脑实质高密度影分布的位置及对脑出血转化和症状性颅内出血的预测作用进行分析。结果(1)高密度影组单独大脑中动脉闭塞患者比例明显高于非高密度影组,组间差异有统计学意义(P<0.05),其余基线资料组间差异均无统计学意义(均P>0.05)。(2)相对于非高密度影组患者,高密度影组患者脑出血转化比例更高[81.5%(44/54)比0],组间差异有统计学意义(χ^(2)=57.391,P=0.01)。(3)机械取栓术后即刻DSA平板头部CT对于术后24 h脑出血转化预测的敏感度和阴性预测值均为100.0%,特异度为78.3%,阳性预测值为81.5%,对术后24 h症状性颅内出血预测的敏感度和阴性预测值均为100.0%,特异度为55.4%,阳性预测值为46.3%。(4)对患者机械取栓后即刻DSA平板头部CT扫描后出现脑实质高密度影的分布进行分析,单独基底节区或大脑皮质存在高密度影的患者,术后24 hObjective To evaluate the predictive value of DSA flat-panel brain CT immediately after mechanical thrombectomy for intracranial hemorrhage transformation 24 hours after operation in patients with acute cerebral infarction cauksed by anterior circulation large vessel occlusion.Methods A retrospective analysis was made on 90 patients who were diagnosed as acute anterior circulation large vessel occlusion with cerebral infarction and underwent mechanical thrombectomy from January 2019 to August 2021 in the Department of Cerebrovascular Diseases of Hainan Provincial People′s Hospital.All patients underwent DSA flat-panel brain CT scan immediately after operation.Head CT was reexamined 24 hours after mechanical thrombectomy to determine whether there was transformation of intracranial hemorrhage.According to whether there was high-density shadow of brain parenchyma in DSA flat-panel brain CT immediately after operation,they were divided into high-density shadow group(54 cases)and non-high-density shadow group(36 cases).The baseline data and postoperative vascular recanalization of the two groups were recorded and analyzed(evaluated by modified thrombolysis in cerebral infarction score[mTICI]grade,mTICI≥2b grade as successful recanalization),as well as clinical prognosis 3 months after operation(assessed by modified Rankin scale[mRS]score;mRS 0-2 score was defined as good prognosis,3-6 score was defined as poor prognosis),and the transformation of intracranial hemorrhage within 24 hours after operation(evaluated according to the first head CT or MRI and re-examination of head CT or MRI after cerebral infarction)and the occurrence of symptomatic intracranial hemorrhage.The location of high-density shadow distribution of brain parenchyma on DSA flat-panel CT after operation and its predictive effect on the transformation of intracranial hemorrhage and symptomatic intracranial hemorrhage were analyzed.Results(1)The proportion of patients with solo middle cerebral artery occlusion in the high-density shadow group was

关 键 词：脑梗死 机械取栓 脑出血转化 DSA平板CT 

分 类 号：R743.3[医药卫生—神经病学与精神病学]