CT perfusion-guided patient selection for endovascular treatment of acute ischemic stroke is safe and effective
CT perfusion-guided patient selection for endovascular treatment of acute ischemic stroke is safe and effective
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DOI：
10.1136/neurintsurg-2011-010067
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发表时间：
2012-07-01
影响因子：
4.8
通讯作者：
Adams, Robert
中科院分区：
文献类型：
--
作者：
Turk, Aquilla;Magarik, Jordan Asher;Adams, Robert
背景：急性缺血性卒中的传统治疗是基于静脉和动脉内治疗的时间标准。然而，最近的证据表明，基于图像的标准可能有助于选择患者进行动脉内介入治疗。方法对南卡罗来纳医科大学急诊科就诊、美国国立卫生研究院卒中评分为>；=8的缺血性卒中患者进行回顾性评估。CTP图对半影区和梗塞的存在进行了定性评估。选择的患者使用半暗带系统进行了咬合的机械抽吸。然后在90天或最接近90天的随访中使用改良的Rankin量表(MRS)记录功能结果。出现症状至腹股沟血管通路的中位时间为6.3h，有8例(15%)出现蛛网膜下腔出血、脑实质出血、脑室出血等出血并发症。以CTP为基础进行选择后，将患者分为两组进行分析：从症状开始到血管内治疗6h。两组的功能结果没有差异(38.5%和40.7%实现了90天的MRS
Background Traditional treatment in acute ischemic stroke is based on time criteria when administering intravenous and intra-arterial therapies. However, recent evidence suggests that image-based criteria may be useful for selecting patients for intra-arterial interventions. The use of CT perfusion (CTP)-based criteria, regardless of time from symptom onset, in patient selection for intra-arterial treatment of ischemic stroke was assessed.Methods Patients with ischemic stroke who presented to the emergency department at the Medical University of South Carolina with a National Institute of Health Stroke Scale score of >= 8, regardless of time from symptom onset, were assessed retrospectively. CTP maps were qualitatively assessed for the presence of penumbra and infarction. Selected patients underwent mechanical aspiration of their occlusion using the Penumbra system. Functional outcome was then recorded using the modified Rankin scale (mRS) at 90 days or the closest follow-up to 90 days.Results 53 patients were included in the study. The median time from symptom onset to groin vascular access was 6.3 h. Eight patients (15%) had bleeding complications including subarachnoid hemorrhage, parenchymal hemorrhage and intraventricular hemorrhage. After CTP-based selection, the patients were divided into two groups for analysis: 6 h from symptom onset to endovascular procedure. No difference was found in functional outcome between the two groups (38.5% and 40.7% achieved 90-day mRS