Scoring flow restoration in cerebral angiograms after endovascular revascularization in acute ischemic stroke patients
Scoring flow restoration in cerebral angiograms after endovascular revascularization in acute ischemic stroke patients
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DOI：
10.1007/s00234-014-1460-x
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发表时间：
2015-03-01
期刊：
影响因子：
2.8
通讯作者：
von Kummer, Ruediger
中科院分区：
文献类型：
--
作者：
Gerber, Johannes C.;Miaux, Yves J.;von Kummer, Ruediger
血管内血运重建技术越来越多地用于治疗急性缺血性卒中患者的动脉闭塞。为了监测和交流治疗结果，需要一种有效的、可重复的、临床相关的、但易于使用的数字减影血管造影术的动脉再通和组织再灌注分级方案。理想的评分系统应考虑治疗前的靶动脉病变、灌注不足和侧支状态，并测量血流恢复后的再通、再灌注、早期静脉分流、血管痉挛以及远端栓塞。目前，正在使用各种不同的血流恢复量表，包括心肌梗死溶栓评分系统、脑梗死溶栓评分和动脉闭塞病变评分，这些评分描述了局部再通结果。这些评分在整个文献中的使用并不均匀，经常被修改，也没有完全记录，这使得它们无法比较研究之间的治疗效果。此外，这些评分均未涵盖上述所有方面，也无法令人满意地描述所有相关血管造影结果，并且关于其可靠性和临床结局预测能力的数据很少。我们的目的是审查和说明不同的血运重建量表，讨论其优点和局限性，以及有关标准化，可靠性测试和结果预测的可用数据。此外，我们给出了使用的规模，并显示潜在的陷阱的例子。
Endovascular revascularization techniques are increasingly used to treat arterial occlusions in patients with acute ischemic stroke. To monitor and communicate treatment results, a valid, reproducible, and clinically relevant, yet easy to use grading scheme of arterial recanalization and tissue reperfusion for digital subtraction angiography is needed. An ideal scoring system would consider the target arterial lesion, the perfusion deficit, and the collateral status before treatment and measure recanalization, reperfusion, early venous shunting, vasospasm, as well as distal embolization after flow restoration. Currently, a variety of different flow restoration scales are in use, including the Thrombolysis in Myocardial Infarction scoring system, the Thrombolysis in Cerebral Infarction score, and the Arterial Occlusive Lesion score, which describe the local recanalization result. These scores are not used homogeneously throughout the literature, are often modified and not fully documented, which make them inept to compare treatment effects across studies. In addition, none of these scores cover all of the above-mentioned aspects, nor are they able to describe satisfactorily all relevant angiographic findings, and data on their reliability and predictive power regarding clinical outcome are sparse. We aimed to review and illustrate the different revascularization scales, discuss their advantages and limitations as well as the available data regarding standardization, reliability testing, and outcome prediction. In addition, we give examples for the use of the scales and show potential pitfalls.