基于DSA及CTPI的大脑中动脉重度狭窄支架植入术高灌注脑出血术前风险预测  

Preoperative Risk Prediction of Hyperperfusion Cerebral Hemorrhage for Stenting of Severe Stenosis of Middle Cerebral Artery Based on DSA and CTPI

作　　者：丁奇 王立忠 王翀昊[2] DING Qi;WANG Lizhong;WANG Chonghao(The First Hospital of Zhangjiakou City,Zhangjiakou 075000,China;Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]张家口市第一医院,河北张家口075000 [2]首都医科大学附属北京天坛医院,北京100050

出　　处：《北华大学学报（自然科学版）》2025年第1期55-59,共5页Journal of Beihua University（Natural Science）

基　　金：河北省技术创新引导计划项目(18247788D)。

摘　　要：目的 基于数字减影血管造影技术(DSA)及脑CT灌注成像(CTPI)预测大脑中动脉重度狭窄支架植入术高灌注脑出血(HICH)的术前风险。方法 选取153例经支架植入(CAS)治疗的大脑中动脉重度狭窄(狭窄率70%~99%)患者,其中,5例发生了HICH(HICH组),148例未发生HICH(非HICH组)。对比分析两组患者临床基线数据、CTPI及脑动脉侧支循环代偿状态;t检验分析计量资料,Fisher检验分析计数资料。结果 HICH组和非HICH组各指标比较:患者从发病到手术的时间≤21 d(P<0.05);平均通过时间(MTT)、达峰时间(TTP)(P<0.05),rMTT、rTTP(P<0.001);侧支循环未开放、Ⅲ级侧支循环开放(P<0.05)。结论 临床基线数据(从发病到手术的时间≤21 d)、CTPI指标(MTT、TTP、rMTT、rTTP)、脑动脉侧支循环代偿状态(Ⅲ级侧支循环开放、侧支循环未开放)可作为大脑中动脉重度狭窄植入高灌注脑出血的预测因子。Objective Prediction of preoperative risk of high perfusion cerebral hemorrhage(HICH) for stenting of severe middle cerebral artery stenosis based on digital subtraction angiography(DSA) and cerebral CT perfusion imaging(CTPI).Methods One hundred and fifty-three patients with severe stenosis of the middle cerebral artery(70% to 99% stenosis) treated with stent implantation were selected,of whom,5 developed HICH(HICH group) and 148 did not develop HICH(non-HICH group).Comparative analysis of clinical baseline data,CTPI,and DSA cerebral arterial tertiary collateral circulation compensation between the two groups of patients.Measurement data were compared using t-test,and counting data were compared using Fisher test.Results Comparison of various indicators between HICH group and non-HICH group,patients had a time from onset to surgery ≤21 d(P<0.05);mean transit time(MTT) and time to peak(TTP)(P<0.05),rMTT and rTTP(P<0.001);the difference between non open collateral circulation and open level III collateral circulation was statistically significant(P<0.05).Conclusion Clinical baseline data(time from onset to surgery ≤21 d),CTPI indices(MTT,TTP,rMTT,rTTP),and cerebral arterial collateral circulation compensation status(grade Ⅲ collateral circulation open,collateral circulation unopened) can be used as predictors of implantation of hyperperfusion cerebral hemorrhage with severe stenosis of the middle cerebral artery.

关 键 词：大脑中动脉重度狭窄支架植入术 高灌注脑内出血 DSAⅢ级侧支循环 脑CT灌注成像 风险预测 

分 类 号：R651[医药卫生—外科学]