基于MRA DWI成像的不同方法对急性缺血性脑卒中患者机械取栓的术前评估  

Preoperative assessment of mechanical thrombolysis in patients with acute ischaemic stroke by different methods based on magnetic resonance angiography and diffusion weighted imaging

作　　者：林雪琪 吴迎春 LIN Xueqi;WU Yingchun(Ordos Clinical Medical College,Inner Mongolia Medical University/Ordos Central Hospital,Ordos 017000,China)

机构地区：[1]内蒙古医科大学鄂尔多斯临床医学院鄂尔多斯市中心医院,内蒙古鄂尔多斯017000

出　　处：《中国实用神经疾病杂志》2025年第3期382-386,共5页Chinese Journal of Practical Nervous Diseases

基　　金：内蒙古自治区科技计划项目(编号:2022YFSH0131);2022年度自治区卫生健康科技计划项目(编号:202202370);内蒙古医科大学联合基金项目(编号:YKD2021LH070)。

摘　　要：对于急性缺血性脑卒中患者,持续成功的血管再通是临床结局重要的预后因子,当前取栓的再通率可达90%,但治疗后患者的良好预后比例仅为40%~50%,快速对急性缺血性脑卒中患者进行术前评估,最大限度地提高临床获益并防止无效甚至有害的再灌注是当前研究的热点,多项具有里程碑意义的大型试验根据闭塞位置、卒中发作时间和可接受的梗死负荷ASPECTS≥6或梗死体积<70 mL选择患者。本文通过检索国内外相关文献及指南,对基于MRA、DWI成像进行的颅内血管状态、梗死体积、梗死位置的评估方法及其在机械取栓患者中的应用进展进行综述,期待能为临床快速、准确筛选出适合机械取栓的患者提供更多依据,并帮助完善急性缺血性脑卒中诊疗指南。Sustained successful revascularisation is an important prognostic factor for clinical outcome in patients with acute ischaemic stroke.Currently,the revascularization rate with thrombolysis can be as high as 90%,but the proportion of patients with good prognosis after treatment is only 40%to 50%.Rapid pre-procedural evaluation of patients with acute ischaemic stroke to maximise clinical benefit and prevent ineffective or even detrimental reperfusion is a hot topic of research at present.Several large landmark trials have selected patients based on occlusion location,stroke onset time,and acceptable infarct load ASPECTS≥6 or infarct volume<70 mL.In this article,we reviewed the methods of intracranial vascular status,infarct volume,and infarct location assessment based on MRA,DWI imaging,and their application to patients undergoing mechanical thrombolysis by reviewing the relevant domestic and international literature and guidelines,and we hope to provide a useful tool for the clinical evaluation of patients with acute ischemic stroke.It is expected to provide more evidence for the rapid and accurate screening of patients suitable for mechanical thrombolysis and to improve the guidelines for the diagnosis and treatment of acute ischemic stroke.

关 键 词：急性缺血性脑卒中 磁共振血管成像 弥散加权成像 梗死位置 梗死体积 机械取栓术 信号强度比 

分 类 号：R743.3[医药卫生—神经病学与精神病学]