【摘要】 【目的】探讨多模式CT在Solitaire支架取栓治疗急性缺血性卒中的影像评估价值。【方法】选择从2015年1月至2016年6月在我院临床诊断为急性缺血性卒中62例患者,在发病3～8 h内行多模式CT检查,包括CT平扫(NCCT)、CT血管成像(CTA)、CT灌注成像(CTP),采用改良的血管TICI分级标准(mTICI)评估血管栓塞情况,通过CTA及CTP参数评估责任血管及血流灌注状态,初步判断患者行Solitaire支架取栓的可行性。患者行支架取栓术后24 h再次行多模式CT检查评估责任血管情况,患者入院时和取栓术后72 h分别进行美国国立卫生研究院神经功能缺损评分(NIHSS)评估神经功能情况。【结果】经多模式CT检查共筛选出34例患者有支架取栓适应证。行支架取栓术后复查多模式CT,血管再通成功30例(30/34),成功率88.2%。取栓治疗的34例患者中,术前CTP成像提示存在缺血半暗带(IP),表现为IP与健侧镜像区相比,脑血流量(CBF)显著降低,脑血容量(CBV)轻度降低,达峰时间(TTP)及平均通过时间(MTT)显著延长,差异有统计学意义(P <0.01);患者取栓术后责任区域相对脑血流量(rCBF)、相对脑容量(rCBV)、相对达峰时间(rTTP)、相对平均通过时间(rMTT)值与术前对比,rCBF、rCBV升高,rTTP、rMTT缩短,差异有统计学意义(P <0.01);术后72 h患者NIHSS评分与入院时比较其差异有统计学意义(P <0.01)。【结论】多模式CT对急性缺血性卒中患者行Solitaire支架取栓治疗具有指导作用和重要评估价值。更多还原

【Abstract】 【Objective】To explore the image evaluation value of multi-model CT in the treatment of acute ischemic stroke with Solitaire stent embolectomy.【Methods】A total of 62 patients diagnosed with acute ischemic stroke from January 2015 to June 2016 in Guangdong Second Provincial General Hospital were included in this study. Multi-model CT inspection,including CT scan(NCCT),CT angiography(CTA)and CT perfusion imaging(CTP),was performed in all patients within 3～8 h. The improved vascular TICI classification standard(mTICI)was used to assess vascular embolization,and we evaluated the responsible vessels and blood perfusion state by CTA and CTP blood vessels,to determine the feasibility of embolectomy with Solitaire stent preliminarily. The patients underwent multi-mode CT examination 24 h after stent embolization to evaluate the responsible vessels. NIHSS was used to assess the neurological function at admission and 72 h after stent embolization.【Results】A total of 34 patients with indication of stent thrombus removal were selected by multi-mode CT examination from 62 patients. Re-examination of multi-mode CT after stent thrombus removal showed that 30 of the 34 cases(30/34,the successful rate was 88.2%)gained success in vascular recanalization. Before the stent thrombus removal of the 34 patients,CTP imaging showed ischemic penumbra(IP),and there was significant decrease in cerebral blood flow(CBF)and slight decrease in cerebral blood volume(CBV),significantly prolonged peak time(TTP)and mean transit time(MTT)compared with the contralateral image area. The difference is statistically significant(P < 0.01). After the stent thrombus removal,the relative cerebral blood flow(rCBF)and relative cerebral blood volume(rCBV)were elevated,the relative peak time(rTTP)and relative mean transit time(rMTT)were shortened. The difference is statistically significant(P < 0.01). Compared with admission,there is significant statistical difference in the NIHSS score of patients 72 h after operation(P < 0.01).【Conclusion】Multi-model CT has guiding effect and important evaluation value in the treatment of acute ischemic stroke patients with Solitaire stent thrombolysis.更多还原