[1]黄书翰,李小树,刘承春,等.平扫CT与脑血容量 ASPECTS错配患者进行血管内治疗的安全性与有效性研究[J].第三军医大学学报,2019,41(09):891-897.
 HUANG Shuhan,LI Xiaoshu,LIU Chengchun,et al.Safety and efficacy of endovascular treatment for patients with a mismatch between non-contrast CT and CBV ASPECTS[J].J Third Mil Med Univ,2019,41(09):891-897.
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平扫CT与脑血容量 ASPECTS错配患者进行血管内治疗的安全性与有效性研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第09期
页码:
891-897
栏目:
临床医学
出版日期:
2019-05-15

文章信息/Info

Title:
Safety and efficacy of endovascular treatment for patients with a mismatch between non-contrast CT and CBV ASPECTS
作者:
黄书翰李小树刘承春吴娅梁春荣李君李玮张猛
1400042 重庆,陆军军医大学(第三军医大学)大坪医院:神经内科1,放射科2
Author(s):
HUANG Shuhan1 LI Xiaoshu1 LIU Chengchun1 WU Ya1 LIANG Chunrong1 LI Jun2 LI Wei1 ZHANG Meng1

1Department of Neurology, 2Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400010, China

关键词:
急性缺血性卒中大血管闭塞血管内治疗CT灌注
Keywords:
acute ischemic stroke large vessel occlusion endovascular treatment CT perfusion
分类号:
R181.32; R741.04; R742.307
文献标志码:
A
摘要:

目的探讨存在平扫CT(noncontrast computed tomographic,NCCT)脑血容量(cerebral blood volume,CBV)Alberta卒中项目早期CT评分(ASPECTS)<0(NC<0)的患者(即平扫CT低密度范围大于CBV下降区域,两者存在错配)进行血管内治疗(endovascular treatment,ET)的安全性与有效性,并观察相关预测指标对ET预后的作用。方法收集本院2015年1月至2018年8月连续就诊的前循环颅内大血管闭塞的血管内治疗290例患者进行回顾性研究。根据NC评分分为NC<0组和NC≥0组;安全性指标为90 d死亡、严重颅内出血、症状性颅内出血(symptomatic intracranial hemorrhage,sICH);有效性指标为住院7 d、出院NIHSS评分及90 d良好预后(mRS≤2)。比较两组间差异,并通过多因素Logistic回归分析影响良好预后的相关因素。结果符合入组条件共有144例患者,其中NC<0组25例,NC≥0组119例。与NC≥0组比较,NC<0组患者具有更低的NCCT ASPECTS[(6.96±1.77) vs (8.73±1.25),P<0.001],同时两组间责任血管分型(P=0.036)、穿刺到再通时间差异均有统计学意义(P=0.017)。两组的安全性与有效性差异均无统计学意义(P>0.05)。多因素回归模型当中,CBV ASPECTS(P=0.010,OR=1.460,95%CI=1.095~1.945)是预测良好预后的独立指标。结论NC<0组的患者可以从ET中获益,并且未增加颅内出血风险,NCCT低密度不应作为排除或判断ET预后不佳的标准,需根据CBV图像进一步详细评估。

Abstract:

ObjectiveIn acute ischemic stroke (AIS), the low density range of noncontrast computed tomography (NCCT) is larger than that of cerebral blood volume (CBV) from time to time, and there is a mismatch between them. The study aimed to study the safety and efficacy of endovascular treatment (ET) in the patients with NCCTCBV Alberta stroke program early CT score (ASPECTS)<0 (NC<0) and explore the role of related predictors in the prognosis. MethodsClinical data of 290 consecutive patients with anterior circulation intracranial vascular occlusion undergoing ET in our hospital from January 2015 to August 2018 were collected to conduct a retrospective study. According to NC score, they were divided into NC<0 and NC>0 groups. The safety outcome were assessed by 90 days of death, severe intracranial hemorrhage, symptomatic intracranial hemorrhage (sICH), and the efficacy outcome included National Institutes of Health Stroke Scale (NIHSS) score at day 7 or discharge, and good functional outcome (mRS≤2) at day 90. The differences between the NC<0 and ≥0 groups were compared, and the related predictors for good prognosis were explored by multivariate logistic regression analysis. ResultsA total of 144 patients were eligible for our inclusion criteria, of 25 in the NC<0 group and 119 in the NC≥0 group. The NC<0 group had lower NCCT ASPECTS than the other group (6.96±1.77 vs 8.73±1.25, P<0.001). Meanwhile, significant differences were seen in the classification of vessels (P=0.036) and the time from puncture to recanalization (P=0.017) between the 2 groups. There were no significant differences in safety and efficacy between the 2 groups. Multivariate regression model showed that CBV ASPECTS (P=0.010, OR=1.460, 95%CI=1.095~1.945) was an independent predictor for good prognosis. ConclusionThe patients with NC<0 are benefited from ET without increasing risk of intracranial hemorrhage. The lowdensity lesions of NCCT should not be used as a criterion for excluding or judging the poor functional outcome of ET, but should be further evaluated according to CBV images.

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更新日期/Last Update: 2019-05-08